1        Columbia  (Hmucrstty 
intlicCitt'of  i1c\M  OorU 

College  of  ^Dlji'sietans  ano  burgeons 


Jxefereuce  ?Ubrarp 


Presented  by 

R.  WILLIAM  J.  GIES 

/o  enrich  the  library  resourevs 
available  to  holders 

GIES  FELLOWSHIP 

in  Biological  Chemistry 


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s^oul^uJ  <H-   ZAsOU&Z 


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in  2010  with  funding  from 
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ORTHODONTIA 
PRACTICALLY   TREATED 


DESIGNED  FOR  THE  USE  OF  BOTH 
PRACTITIONER    AND    STUDENT 


MILAND    A.  KNAPP,   D.  D.  S., 

Former  Instructor  of  Orthodontia  in  the  Dental  Department  of 

the  University  of  Minnesota,  Minneapolis,  Minn. 

Former  Professor  of  Orthodontia  at  the 

Northwestern  University  Dental 

School,  Chicago,  111. 

Author  of  "Teeth  Regulation,"  "A  New  System  of  Teeth 

Regulation  Without  Soldering,"   "The  Knapp 

System  of  Teeth  Regulation  for 

Major  Protrusion." 


FIRST    EDITION, 

with   Five   Hundred  and  Sixty-Four   Illustrations. 


MINNEAPOLIS,  MINNESOTA: 
Press  of  Harrison   6c   Smith   Co. 

1904. 


To  all  those  interested  in  the  advancement 
of  Dental  Science  in  all  its  branches, 
this    work    is    respectfully   dedicated. 


COPVRIOHI      >    :    >■"■     Mil. and   A.    KNAPP 
\i  I.    Kl'.ilis    Ki  Ml' vi  I. 


PREFACE 


In  preparing  this  work  it  has  been  the  author's  aim  to  make 
it  pre-eminently  practical,  so  as  to  be  of  the  greatest  possible 
assistance  to  those  whose  experience  in  this  line  of  work  has  been 
limited. 

Discussions  relative  to  the  causes  of  dental  irregularities,  com- 
parative anatomy  of  the  teeth  and  histology  of  the  peridental 
membrane  and  alveolar  process,  which  have  been  so  thoroughly 
covered  by  other  writers  on  Orthodontia,  have  been  entirely  omit- 
ted. Also,  no  reference  is  made  to,  nor  cuts  shown  of,  the  older 
and  obsolete  appliances  ;  for  while  these  may  be  of  interest  to  us 
historically,  they  are  of  no  practical  value  at  the  present  time. 

The  fact  that  Orthodontia  is  far  behind  all  other  branches  of 
dental  science  cannot  be  disputed,  and  the  author  believes  this 
to  be  due  more  to  the  lack  of  proper  means  for  accomplishing  the 
desired  results,  than  from  any  other  cause. 

All  the  appliances  illustrated  and  described  in  the  following 
pages  have  been  thoroughly  tested  by  the  author  in  a  great  many 
cases,  and  most  of  them  by  other  practitioners,  and  their  ef- 
ficiency and  practicability  can  be  relied  upon. 

The  illustrations  are  made  from  photographs  of  the  appliance 
in  position  on  the  plaster  cast.  Drawings  are  also  given,  with 
the  indicative  number  of  each  part  used,  which  gives  the  operator 
definite  instructions  regarding  the  assembling  of  the  different 
forms  of  appliances. 


VI  PREFACE 

More  consideration  lias  been  given  to  the  clear  illustration 
of  the  appliances  for  the  treatment  of  various  cases  than  to  the 
description,  as  a  more  definite  idea  of  an  appliance  can  be  ob- 
tained from  an  illustration  than  from  a  lengthy  description.  The 
author  has  endeavored  to  make  everything  clear  and  concise  so  as 
to  consume  as  little  of  the  operafc  ir's  time  as  possible. 

The  author  takes  this  opportunity  for  expressing  his  apprecia- 
tion of  the  interest  taken  he  Dr.  W.  Storer  How,  of  Philadelphia, 
Pa.,  in  the  success  of  The  Knap])  System  of   Teeth  Regulation. 

He  was  the  first  person  to  whom  the  appliances  were  shown, 
and  gave  the  author  great  encouragement  in  placing  them  on  the 
market.  He  also  gave  much  valuable  assistance  in  preparing  for 
the  press  the  first  and  second  editions  of  "Teeth  Regulation,"' 
puhlished  in  1899  and  [900  by  The  S.  S.  White  Dental  Mfg.  Co. 


CONTENTS 

CHAPTER  I. 

Diagnosis    I 

The  Diagnosis  of  Dental  Irregularities — Rules  for  De- 
termining the  Proper  Manner  of  Proceeding  With 
the  Correction  of  the  Condition — Points  to  he  Con- 
sidered— Lines  of  Proportion — Divisions  and  Sub- 
Divisions  of  the  Face. 

CHAPTER  II. 

Extraction    34 

Results  of  the  Injudicious  Extraction  of  Teeth,  Both 
Temporary  and  Permanent — Rule  for  the  Extraction 
of  Teeth. 

CHAPTER  III. 

Supernumerary   Teeth    41 

Their  Shapes — Position — Damage  Resulting — Extrac- 
tion of  Supernumerary  Teeth. 

CHAPTER  IV. 
Age  at  Which  Correction  Can  Best  be  Accomplished.  .     46 

CHAPTER  V. 

Tooth  Movement 51 

The  Distance  Teeth  May  be  Safely  Moved  in  Twenty- 
four  Hours — Effect  of  Age  and  Direction  of  Move- 
ment. 

CHAPTER  VI. 

Author's  Appliances    57 

Description  and  Explanation  of  the  Use  of  Each  Individ- 
ual Part. 


Vlll  CONTENTS 

CHAPTER  VII. 
The  Jack-screw  102 

Description  of  the  Several  Forms  as  Adapted  to  Differ- 
ent Purposes. 

CHAPTER  VHP 

Jack-screw  Anchorage    113 

CHAPTER  IX. 

The  Double  Jack-screw    121 

CHAPTER  X. 

The  Triple  Jack-screw   123 

CHAPTER  XI. 

Stud  Bar  Appliances  125 

CHAPTER  XIT. 

Arch  Bar  Appliances 141 

The  Different  Forms  and  Modifications — Practical  Ap- 
plications. 

CHAPTER  XIII. 
Rot  \tiox   [59 

CHAPTER   XIV. 
Arch    Expansion   181 

CHAPTER   XV. 
Tin.  S(  kia\  Band  as  a  Regulating  Device 200 

CHAPTER  XVI. 

Major  Protrusion  207 

CHAPTER   XVII. 
Retaining  Devices   264 

<  :hapter  xviil 

MlSCELLANEOl   -   CASES.   THEIR   CORRECTION    AND    RETENTION    280 


CHAPTER  I. 

THE  DIAGNOSIS  OF  DENTAL   IRREGULARITIES,    WITH    RULES 
FOR  DETERMINING  THE  PROPER  MANNER  OF 
PROCEEDING   WITH    THE   CORREC- 
TION OF   THE   CONDITION. 

i.  A  cast  made  from  the  impression  of  an  irregular  arch 
is  not  sufficient  to  determine  the  proper  method  of  treating  any 
case  of  dental  irregularity,  as  a  cast  of  either  jaw  shows  very 
little  of  the  actual  condition  of  the  mouth.  It  is  absolutely 
necessary  to  take  into  consideration  several  points  regarding 
the  expression  of  the  face  and  lips,  the  occlusion  of  the  teeth, 
and  the  position  of  the  arches  in  relation  to  each  other. 

2.  There  are  four  points  to  be  considered  in  determining 
the  treatment  of  any  case  of  irregularity. 

First,  the  prominence  of  the  lips,  determined  by  the  lines 
of  proportion. 

Second,  the  center  line  (a  line  drawn  through  the  inter- 
dental space  between  the  central  incisors,  upper  and  lower). 

Third,  the  occlusion  of  the  upper  first  bicuspid  teeth. 

Fourth,  the  age  of  the  patient. 

It  is  also  imperative  that  normal  conditions  should  be 
thoroughly  understood  before  abnormalities  can  be  recognized 
and  the  proper  line  of  treatment  determined  upon. 


2  ORTHODONTIA. 

3.  To  accurately  and  quickly  determine  whether  a  pa- 
tient's face  is  normal  or  abnormal  and  what  changes  would  be 
desirable  to  improve  the  expression  of  the  features,  the  author 

Fie.  1. 


divides  the  ideal  face  into  three  divisions  by  imaginary  lines 
which  intersect  at  right  angles  a  perpendicular  line  drawn  as 

Fig.  2. 


/ 


3rd  DIVISION 


£^ 


-«>=*- 


r 


2nd  DIVISION 


1st  DIVISION 


shown  in   li.ur-    »•     This  line  touches  the  nasal  and  mental  emi 

nences,   passing   through   the   ala  of  the   nose.     These   three 
divisions  arc  bounded  by  four  lines,  the  firsl  passing  just  below 


DIAGNOSIS.  3 

the  inferior  maxillary  bone;  the  second,  through  the  ala  of  the 
nose  ;  the  third,  through  the  super-orbital  ridge  ;  and  the  fourth, 
at  about  the  hair  line.     See  Fig.  2. 

4.  These  four  lines  are  drawn  parallel  to  each  other  and 
at  right  angles  to  the  perpendicular  line  except  sometimes  the 
first,  which  may  or  may  not  be  at  right  angles  to  the  perpen- 
dicular line,  accordingly  as  the  perpendicular  line  is  one 
straight  line  or  two  straight  lines,  which  form  an  obtuse  angle 
at  the  ala  of  the  nose.  The  space  included  between  the  first 
and  second  lines  we  will  call  the  first  division  ;  that  between 

Fig-  3- 


3rd  SUB  DIVISION 
2nd  SUB  DIVISION 
1st  SUB  DIVISION 


the  second  and  third  lines,  the  second  division  ;  and  that  be- 
tween the  third  and  fourth  lines,  the  third  division.  These 
three  divisions  should  all  be  equal,  and  it  is  surprising  to  note 
how  closely  all  well-formed  faces  accord  with  this. 

5.  The  first  division  is  the  one  most  important  in  consid- 
ering cases  of  abnormality  and  this  also  is  divided  into  three 
equal  sub-divisions  by  two  lines  ;  one  passing  at  right  angles 
to  the  perpendicular  through  the  opening  between  the  lips,  the 
other  equally  dividing  the  space  between  this  line  and  the  line 


i  IRTHI IDON  flA. 


passing  just  below  the  inferior  maxillary  bone.  The  length 
of  the  upper  lip  should  be  one-third  the  distance  from  the  ala 
of  the  nose  to  the  lower  edge  of  the  inferior  maxillary  bone  and 

Fig.  4- 


the   perpendicular  line   should  touch    the   nasal   eminence,   the 
lower  lip.  and  the  mental  eminence,  as  in  Fig.  3. 

Fig-  5- 


ib 


6 


In  all  persons  of  pleasing  expression  it  will  be  found  thai 
the  first  division  with  its  three  sub-divisions  will  be  so  near 
the  hI<-,-i]  that  it  is  difficull  to  detecl  anv  difference. 


DIAGNOSIS.  5 

6.  The  obtuse  angle  formed  by  the  break  in  the  perpen- 
dicular line  at  the  ala  of  the  nose  may  vary  to  the  extent  of 
fifteen  degrees  without  disfiguring  the  appearance.  See  Fig.  4. 
When  there  is  a  break  in  the  perpendicular  line  the  obtuse  an- 
gle is  almost  always  posterior  to  it,  as  in  Fig.  4.  In  a  few 
cases,  however,  the  obtuse  angle  is  anterior  to  the  perpendicu- 
lar line,  as  shown  in  Fig.  5.  This,  in  the  author's  opinion,  is 
a  condition  much  less  desirable  than  when  the  obtuse  angle  is 
posterior  to  the  line,  and  should  be  considered  an  abnormality. 

This  deformity  is  generally  caused  by  the  extraction  of 
the  cuspid  teeth,  the  early  loss  of  the  upper  first  molars,  or  the 
eruption  of  the  upper  incisors  and  laterals  inside  the  lower  arch. 

7.  The  first  division  with  its  three  sub-divisions  is  the 
most  important  point  in  determining  the  treatment  of  any 
case.  The  lips,  to  be  normal,  may  come  equally  in  contact 
with  the  perpendicular  line,  or  the  upper  may  project  slightly 
beyond  it.  In  fact,  the  ideal  condition  is  with  the  upper  lip 
projecting  slightly. 

8.  The  third  sub-division  of  the  first  division  determines 
the  length  of  the  bite.  If  the  third  sub-division  is  greater  than 
one-third  of  the  whole,  improvement  will  be  obtained  by 
lengthening  the  bite.  If  the  third  sub-division  is  less  than  one- 
third,  the  case  will  be  improved  by  shortening  the  bite.  Pa- 
tients with  a  short  upper  lip  will  stand  less  prominence  of  the 
teeth  than  those  with  a  long  upper  lip.  A  short  upper  lip 
must  not  be  confounded  with  one  that  is  prominent,  as  most 
prominent  lips  appear  short  from  an  inability  to  cover  the 
teeth,  while  an  upper  lip  may  be  short  and  not  prominent. 

9.  Fig.  6  shows  a  face  where  the  perpendicular  line  is 
straight.  With  the  perpendicular  line  touching  the  nasal  emi- 
nence and  mental  process  the  upper  lip  is  slightly  anterior  to 
the  line  and  the  lower  slightly  posterior.     The  upper  lip,  which 


o  ORTHODONTIA. 

is  contained  in  the  third  sub-division,  is  exactly  one-third  of  the 
first  division,  as  shown  in  Fig.  vv  and  is,  therefore,  of  the  proper 
length.  Fig.  7  is  a  profile  of  a  face  where  the  perpendicular 
line  is  not  one  straight  line  but  a  combination  of  two  lines 
which  form  an  obtuse  angle  at  the  ala  of  the  nose.  In  this 
case  also  the  upper  lip  is  slightly  more  prominent  than  the 
lower.  Fig.  8  shows  another  profile  where  the  perpendicular 
line  forms  an  obtuse  angle  at  the  ala  of  the  nose,  but  in  this 
case  both  lips  are  of  equal  prominence.  In  the  author's  opin- 
ion a  face  with  the  upper  lip  slightly  more  prominent  than  the 
lower,  as  shown  in  Fig.  7,  or  with  both  lips  of  equal  promi- 
nence, as  shown  in  Fig.  8,  may  be  considered  ideal,  but  in  no 
case  may  the  upper  lip  be  less  prominent  than  the  lower  and 
the  condition  be  ideal. 

10.  In  Fig.  9  the  perpendicular  line  forms  an  obtuse  angle 
at  the  ala  of  the  nose  the  same  as  in  Fig.  7,  but  the  lower  lip 
is  more  prominent  than  the  upper  to  the  same  extent  that  the 
upper  lip  is  more  prominent  than  the  lower  in  Fig.  7. 

A  very  slight  variation  in  the  angle  formed  at  the  ala  of 
the  nose  will  make  a  great  difference  in  the  appearance.  The 
variation  of  the  angle  should  not  be  over  fifteen  degrees;  one 
hundred  and  eighty  degrees,  or  a  straight  line,  being  the  base 
for  figuring. 

11.  Fig.  10  is  the  outline  of  a  face  where  there  is  a  varia- 
tion of  fifteen  degrees  from  a  straight  line  at  the  lower  third. 
Fig.  11  shows  a  case  where  the  lower  jaw  recedes,  making  a 

variation  of  more  than  lift  ecu  degrees.       In  this  ease  there  was 

a  well  developed  chin.  The  improvement  in  the  facial  lines, 
after  moving  the  lower  jaw  forward,  is  shown  in  Fig.  12.  From 
the  models  alone,  shown  in  Fig.  [3,  this  would  seem  to  be  a 
simple  protrusion  case,  but  by  considering  the  facial  lines  it  is 

evident    that    nothing   but    damage  could    result    from    reducing 


DIAGNOSIS. 

Fie.  6. 


Fig.  7. 


DIAGNOSIS. 

Fie.  8. 


Fig.  9. 


DIAGNOSIS. 


I   I 


the  prominence  of  the  upper  jaw.  The  importance  of  consid- 
ering the  facial  lines  in  all  cases  cannot  be  too  strongly  em- 
phasized, for,  as  in  the  case  here  illustrated,  facial  lines  often 

Fier.  10. 


determine,  entirely,  the  proper  method  of  proceeding  with  the 
correction  of  the  irregularity. 

12.     Fig.  14  shows  a  case  where  the  lower  lip  and  chin 
are  of  proper  prominence,  with  a  receding  upper  lip.      The  im- 
Fie:.  11.  Figf.  12. 


provement  in  the  facial  lines,  after  moving  the  upper  teeth  and 
jaw  forward,  is  shown  in  Fig.  15.  Fig.  16  illustrates  an  unduly 
prominent  upper  jaw,  causing  a  protruding  upper  lip,  which. 


12 


ORTHODONTIA. 


from  the  position  of  the  teeth,  appears  to  be  short.  The  im- 
provement in  the  facial  lines,  after  reducing-  the  prominence 
of  the  upper    I  lint  in  no  way   interfering  'with  the  lower)   is 

Fig-  13- 


shown  in  Fig.  17.  Fig.  [8  is  a  profile  of  a  case  where  the  upper 
jaw  protrudes  and  the  chin  is  lacking  in  development.  In  cases 
where  the  mental   process  is  lacking  it   is  impossible  to  get 


Fig.  14. 


Fig.  15. 


ideal  facial  lines.  This  case  was  greatly  improved,  however, 
by  reducing  the  prominence  of  the  upper  jaw. 

13.  There  should  be  a  curve  in  the  upper  lip,  as  in  Fig. 
7  and  Fig.  8.      Fig.  [9  -hows  a  straighl  upper  lip,  due  to  the 

of  prominence  of  the  crowns  of  the  incisor  teeth.  In  Fig. 
20  the  upper  right  firsl  bicuspid  was  extracted  t<»  make  room 


DIAGNOSIS 

Fisr.  [6. 


[3 


Fisr.  17. 


DIAGNOSIS. 


l=i 


Fig.  18. 


DIAGNOSIS.  17 

for  the   cuspid,  whereas  the  right  lateral  and   central  should 
have  been   moved   forward   sufficiently    to   permit  the   cuspid 

Fig.  19. 


to  take  its  proper  position  in  the  arch  and  the  marred  appear- 
ance, shown  in  Fig.  19,  would  have  been  avoided. 

Fief.  20. 


14.  Fig.  21  shows  a  lip  curved  in  exactly  the  wrong  di- 
rection, caused  by  the  inward  slant  of  the  central  incisors. 
As  the  lip  is  normally  full  at  the  corners  of  the  mouth  the 
curve  of  the  lip  will  be  corrected  by  changing  the  slant  of  the 
teeth. 

15.  The  second  point  to  be  considered  is  the  center  line. 
This  is  a  line  drawn  vertically  from  the  nasal  eminence  through 


i8 


ORTHODONTIA. 


the  center  of  the  upper  lip  and  the  center  of  the  chin,  and 
should  coincide  with  a  line  drawn  between  the  central  incisors, 
upper  and  lower.       It  is  generally   sufficient   to  compare   the 

Fie.  21. 


interdental  space  between  the  central  incisors  with  a  line  pass- 
ing from  the  center  of  the  depression  in  the  upper  lip  to  the 

Fier.  22. 


center  of  tin-  chin,  as  shown  in  Fig.  22.      It  is  much  more-  im 
portant  that  the  upper  centrals  should  be  in  the  center  of  the 


DIAGNOSIS. 


19 


face  than  that  the  lowers  should,  as  the  uppers  are  more  con- 
spicuous. Fig.  23  shows  a  line  drawn  between  the  central 
incisors,  which  should  coincide  with  a  line  drawn  as  shown  in 
Fig.  22. 

Fig.  23. 


16.     In  Fig.  24  the  interdental  space  between  the  upper 
central  incisors  coincides  with  that  of  the  lower  and  also  with 

Fig.  24. 


the  center  line  of  the  face,  making  it  necessary  to  move  the 
central  and  lateral  incisors  directly  forward  to  make  room  for 
the  cuspids;  or,  if  the  prominence  of  the  lip  will  not  permit 


20 


ORTHODOX  IMA. 


of  this,  both  upper  first  bicuspids  must  be  extracted,  for  the 
center  line  must  not  be  changed. 

Fig.  25. 


17.  Fig.  25  shows  a  case  of  inlocked  incisor  teeth,  with 
the  center  line  normal,  as  in  Fig.  24.  The  teeth  must,  there- 
fore, be  moved  directly  forward  so  as  to  not  change  the  center 
line. 

Fie-.  26. 


18.  In  Fig.  26  a  different  condition  exists.  By  compar- 
ing a  line  drawn  between  the  lower  central  incisors  with  the 
center  line  of  the  face  they  are  found  to  coincide,  bul  a  line 


DIAGNOSIS. 


21 


drawn  between  the  upper  centrals  is  one-half  the  width  of  a 
central  to  the  right  of  the  center  line  of  the  face.  Therefore, 
in  correcting  the  case  the  teeth  must  be  moved  forward  and 

Fig.  27. 


to  the  left  to  correct  both  the  occlusion  and  the  center  line. 
Fig.  27  shows  the  case  when  completed,  the  center  line  having 
been  moved  to  the  left  until  it  coincides  with  the  center  of  the 
lowers  and  also  with  the  center  line  of  the  face. 

Fie.  28. 


19.  The  third  point  to  be  considered  is  the  occlusion.  To 
determine  whether  the  occlusion  is  normal  or  abnormal  it  is 
the  author's  practice  to  use  the  upper  first  bicuspid  tooth  as  a 


22  ORTHODONTIA. 

"land-mark,"  as  this  tooth  is  most  often  in  position  (that  is, 
erupted),  while  the  cuspid  is  least  often  so.  The  first  per- 
manent molar  is  generally  the  first  tooth  to  he  lost,  and  is  not 
a  good,  reliahle  land-mark. 

Fig.  20. 


An  illustration  of  this  is  shown  in  Figs.  28  and  29.  In 
Fig.  28  the  anterior  buccal  cusp  of  the  upper  first  molar  oc- 
cludes over  the  buccal  groove  of  the  lower  first  molar.     In  Fig. 

Fig.  30. 


29,  which  is  the  left  side  of  the  same  case,  the  upper  first  molar 
occludes  almost  directly  over  the  entire  lower  first  molar,  while 
the  occlusion  of  the  upper  firsl  bicuspid  of  each  side  is  normal. 


DIAGNOSIS. 


23 


It  will  be  noticed  in  Fig.  30  that  the  upper  first  molar  oc- 
cludes much  farther  back  in  relation  to  the  lower  first  molar 
than  the  corresponding  teeth  in  Fig.  29,  although  the  first  bi- 
cuspids occlude  normally  in  both  cases. 

Fig.  31. 


Fig.  32. 


20.  The  upper  first  bicuspid  should  occlude  directly  over 
the  interdental  space  between  the  lower  first  and  second  bi- 
cuspids.    See  Figs.  28,  29  and  30.     A.     When  it  occludes  be- 


24 


ORTHODONTIA. 


twcen  the  lower  first  bicuspid  and  cuspid,  as  is  often  the  case, 
the  upper  bicuspids  and  molars  are  a  step  forward.  See  Fig. 
31.  B.  When  the  upper  first  bicuspid  occludes  directly  over 
the  lower  first  bicuspid  the  upper  bicuspids  and  molars  are 
half  a  step  forward.     See  Fig.  32. 

Fig-  33- 


21.  When  the  upper  bicuspids,  one  or  both,  occlude  a 
step  forward  and  the  upper  lip  must  not  be  made  more  promi- 
nent, extraction  is  necessary. 

Fig.  34- 


22.     The  fourth  point  to  be  considered,  the  age  of  th<   pa 
ii<-nt.  i>  important.  a>  it  determines  the  amounl  of  movement 
which  may  be  safel)   effected   within  twenty-four  hours,  also 
the  form  of  appliance  to  use  and  the  advisability  of  certain 


DIAGNOSIS. 


25 


operations.  Take,  for  illustration,  a  case  where  the  upper 
central  incisors  occlude  on  or  inside  the  lowers,  and  the  laterals 
stand  too  far  forward.  If  the  patient  were  eight  years  old  an 
appliance  operating"  by  spring  action,  as  shown  in  Fig.  33, 
would  be  sufficient ;  but,  if  the  patient  were  eighteen  or  twenty 
years  old,  it  would  be  necessary  to  use  an  appliance  anchored 
to  the  molars,  as  shown  in   Fig.  34. 

23.     In  the  case  of  a  patient  eight  years  old  the  central 
incisors  might  safely  be  moved  a  short  distance  at  the  rate  of 

Fig-  35- 


one-fiftieth  of  an  inch  in  twenty-four  hours,  while  if  the  pa- 
tient were  twenty  years  old  it  would  be  unsafe  to  move  them 
more  than  one  two-hundredth  of  an  inch  in  the  same  length 
of  time. 

24.  In  every  case  the  operator  is  called  upon  to  treat,  the 
patient  should  be  placed  in  the  chair  so  that  the  operator,  whose 
head  is  on  a  level  with  the  patient's  head,  should  see  the  exact 
profile,  as  in  Fig.  35.     The  operator  should  have  the  imaginary 


26  ORTHODONTIA. 

lines  of  proportion  in  his  mind  and  determine  whether  the  lips 
are  normal;  that  is.  whether  the  upper  lip  should  be  made  more 
prominent,  reduced  in  prominence,  or  will  not  permit  of  any 
variation.  "When  this  is  determined  the  center  line  should  be 
observed  to  see  if  the  line  drawn  between  the  incisors  is  in  the 
center  of  the  face.  The  occlusion  of  the  first  bicuspid  on  each 
side  should  next  be  noted,  and  the  age  of  the  patient  ascer- 
tained. 

A  few  examples  are  here  given  to  illustrate  the  practical 
application  as  to  the  extraction  of  teeth  and  general  treatment 
of  a  case  in  accordance  with  the  four  points  outlined  above. 

25.  Ex.  1.  If  the  upper  lip  should  be  normal  and  there- 
fore not  permit  of  any  more  prominence,  the  center  line  normal 
and  the  upper  bicuspids  of  each  side  occluding  one  step  for- 
ward (see  Fig.  24),  it  would  be  necessary  to  extract  both  upper 
first  bicuspids  to  permit  the  placing  of  the  six  anterior  teeth  in 
proper  line. 

26.  Ex.  2.  If  the  upper  lip  is  prominent,  lower  lip  nor- 
mal, center  line  normal,  upper  first  bicuspids  occlude  one  step 
forward  and  the  six  anterior  teeth  in  perfect  line  (see  Fig.  31), 
it  would  be  1  ;.  to  extract  both  upper  first  bicuspids  to 
reduce  the  prominence,  always  using  occipital  anchorage. 

27.  Ex.  3.  If  the  tipper  lip  is  normal  or  slightly  promi- 
nent, center  line  to  the  right  of  the  center  of  face,  upper  right 
fir.-t  bicuspid  occluding  normally  and  the  upper  left  first  bi- 
cuspid occluding  one  step  forward,  it  would  be  necessary  to 
extract  the  upper  left  firsl  bicuspid  to  place  the  six  anterior 

h  in  proper  line. 

28.  This  is  a  condition  often  occurring  and  the  cuspid  on 
the  side  opposite  from  the  firsl  bicuspid,  which  occludes  a  st<  p 

forward,  has  no  room  in  the  arch.  Figs.  36,  37.  38  and  39 
will  serve  to  illustrate  this  condition. 


DIAGNOSIS. 


27 


Fig.  36. 


FiR-  37- 


DIAGNOSIS. 


29 


Fig.  38. 


Fig-  39- 


DIAGNOSIS.  31 

29.  Fig.  36  shows  the  left  side  of  the  articulated  models. 
The  upper  first  bicuspid  occludes  between  the  lower  cuspid 
and  first  bicuspid,  which  is  one  step  forward  of  normal  oc- 
clusion. 

30.  Fig.  37  is  the  right  side  of  the  articulated  models. 
The  upper  first  bicuspid  of  this  side  occludes  directly  over  the 
interdental  space  between  the  lower  first  and  second  bicuspids, 
which  is  its  normal  position. 

31.  Fig.  38  shows  the  center  line,  which  is  to  the  right  of 
the  center  of  the  face  and  also  of  the  lower  teeth. 

32.  By  studying  only  the  upper  model,  as  shown  in  Fig. 
39,  which  is  so  often  done,  the  upper  right  first  bicuspid  might 
seem  the  proper  tooth  to  be  extracted  in  order  to  bring  the 
cuspid  into  line,  while  if  this  should  be  done,  permanent 
and  irreparable  injury  to  the  patient  would  be  the  result.  Cut, 
by  studying  the  articulated  models  and  taking  into  considera- 
tion the  position  of  the  center  line  and  the  prominence  of  the 
lip,  there  is  but  one  thing  to  do.  That  is,  to  extract  the  upper 
left  first  bicuspid  and  move  the  four  incisor  teeth  to  the  left 
until  there  is  room  for  the  right  cuspid  to  be  placed  in  the  arch. 

33.  Ex.  4.  When  the  upper  lip  is  normal  or  receding  and 
the  occlusion  of  the  first  bicuspid  of  each  side  normal,  (see  Figs. 
40  and  41)  no  teeth  should  be  extracted.  The  four  incisor  teeth 
should  be  moved  forward  or  the  arch  expanded  sufficiently  to 
place  the  six  anterior  teeth  in  line. 

34.  In  Fig.  40  the  four  incisor  teeth  are  in  line,  but  do 
not  stand  forward  sufficiently  to  give  room  for  the  cuspids  to 
take  their  proper  positions  in  the  arch.  The  lower  anterior 
teeth  over-lap  to  some  extent  and  are  crowded  back  on  account 
of  the  abnormal  occlusion  of  the  uppers.  In  such  cases  the 
upper  incisor  teeth  should  be  moved  forward  by  means  of  an 


32 


ORTHODONTIA. 


arch  bar  appliance  on  the  inside  of  the  arch,  the  resistance 
necessary  to 
first  molars. 


necessary  to  move  the  teeth  being'  gained  by  anchoring  to  the 


Fig.  40. 


35.     In  Fig.  41  the  same  condition  exists,  but,  in  addition, 

the  laterals  stand  back  of,  and  are  over-lapped  by,  the  centrals. 

Nevertheless,  exactly  the  same  mode  of  treatment  and  the  same 

form  of  appliance  should  be  used  in  either  case. 

Fig.  41. 


36.  Ex.  5.  In  cases  when-  the  occlusion  of  tin-  upper  firsl 
bicuspids  IS  one  Step  forward  ami  the  upper  lip  is  not  abnor- 
mally prominent,  but  the  lower  lip  and  (bin  recede,  as  shown 
in    Fig.    11.   more   improvement    in    the    facial    lines   will   be   ob 


DIAGNOSIS.  33 

tained  by  moving  the  lower  jaw  forward  than  by  extracting 
the  upper  first  bicuspids  and  reducing  the  prominence  of  the 
upper  jaw.  See  Fig.  12.  It  will  be  noticed  in  Fig.  11  that  the 
upper  lip  is  nearly  straight  and  slants  slightly  backward.  If, 
however,  the  chin  should  recede  and  the  upper  lip  be  promi- 
nent, with  a  forward  curve,  as  in  Fig.  18,  both  upper  first  bicus- 
pids should  be  extracted  and  the  six  anterior  teeth  moved  back. 
37.  It  must  be  remembered  that  in  reducing  the  promi- 
nence of  the  upper  lip  by  moving  the  six  anterior  teeth  back, 
the  teeth  are  not  moved  through  the  alveolar  process,  but  the 
whole  process  containing  the  teeth  is  bent  backward  until  the 
spaces  formerly  occupied  by  the  first  bicuspid  teeth  are  closed, 
thus  reducing  the  size  of  the  superior  maxillary  bones. 


34  ORTHODONTIA. 


CHAPTER  II. 

RESULTS  OF  THE  INJUDICIOUS  EXTRACTION  OF  TEETH. 

38.  When  the  four  points  mentioned  in  the  foregoing 
chapter  are  carefully  considered  in  each  case,  there  will  be  no 
danger  of  injudicious  extraction  of  any  of  the  permanent  teeth. 
Regarding  the  temporary  set ;  much  damage  will  result  from 
the  extraction  of  these  teeth  before  the  time  for  the  appearance 
of  their  permanent  successors.  It  is  much  more  important, 
however,  that  some  of  them  should  remain  in  position  their  full 
length  of  time  than  others. 

3g.  The  second  temporary  molars  should  never  be  ex- 
tracted until  the  ninth  year.  If  these  are  extracted  from  the 
fourth  to  the  sixth  year  to  relieve  toothache,  as  is  so  often 
done,  the  first  molar,  coming  in  at  the  sixth  year,  will  move 
forward,  as  it  has  nothing  to  oppose  it  anteriorly. 

When  the  second  temporary  molar  is  extracted  before  the 
sixth  year  the  first  permanent  molar  nearly  always  occupies 
the  entire  space  which  rightly  belongs  to  the  permanent  second 
bicuspid.  This  causes  the  permanent  teeth  which  are  an- 
terior to  the  molar  to  be  the  width  of  a  bicuspid  forward,  re- 
sulting in  the  condition  described  in   Paragraph  20  A. 

40.  Also,  if  either  of  the  temporary  cuspids  is  extracted 
before  the  twelfth  year  it  permits  either  the  bicuspid  to  move 
forward  or  the  incisor  teeth  to  gradually  recede.  Generally 
the  incisor  teeth  recede,  leaving  no  room  for  the  cuspids  and 
spoiling  the  features. 


INJUDICIOUS  EXTRACTION.  35 

41.  Fig.  42  shows  a  case  where  the  lower  left  temporary 
cuspid  was  extracted  and  the  incisor  teeth  have  moved  back- 
ward and  to  the  left  until  the  space  is  entirely  closed.  This 
makes  it  necessary  to  move  these  teeth  forward  the  full  width 
of  a  cuspid  tooth  before  the  cuspid  can  take  its  proper  position 
in  the  arch.  When  a  case  like  this  is  allowed  to  go  without 
immediate  attention  the  upper  anterior  teeth  are  nearly  always 
disarranged. 

Fig.  42. 


42.  When  the  upper  or  lower  permanent  centrals  erupt 
and  the  space  is  crowded,  never  extract  a  temporary  lateral  to 
make  room  for  the  centrals.  This  will  always  result  in  a 
greater  deformity.  A  much  worse  condition  is  the  result  when 
the  temporary  cuspids  are  extracted  to  make  room  for  the 
laterals.  This  should  never  be  done  under  any  condition 
whatever,  no  matter  how  crowded  the  four  incisor  teeth  may 
be.  A  good  rule  to  follow,  without  any  exception,  is  :  Never 
extract  a  temporary  tooth  to  give  room  for  other  than  its  right- 
ful successor. 

43.  Regarding  the  extraction  of  the  permanent  teeth.  If 
the  lower  first  molars  are  extracted  before  the  eighteenth  or 
twentieth  year  the  lower  arch  will  not  have  sufficient  promi- 


36  ORTHODONTIA. 

nence,  which  will  cause  an  exceedingly  long  over-bite.  In  time 
this  will  cause  the  incisal  edges  of  the  lower  teeth  to  close  back 
of  the  uppers  until  they  nearly,  if  not  quite,  touch  the  gum  and 
both  upper  and  lower  incisor  teeth  have  a  tendency  to  elongate. 

44.  When  the  upper  first  molars  are  extracted  the  upper 
jaw  recedes  and  the  incisal  edges  of  the  uppers  will  strike 
directly  on  top  of  the  lowers.  When  this  condition  occurs  the 
teeth  are  worn  off  rapidly  and  chipped.  In  extreme  cases  the 
teeth  are  worn  nearly  to  the  gum.  This  is  what  the  laity  calls 
"double  teeth  all  the  way  around." 

45.  When  both  upper  and  lower  first  molars  are  extracted 
between  the  tenth  and  the  twelfth  year,  it  causes  both  upper 
and  lower  lips  to  become  deficient  in  prominence,  which  mars 
the  facial  lines,  as  shown  in  Fig.  5. 

46.  When  one  of  the  upper  first  molars  or  one  of  the  bi- 
cuspids is  extracted  the  center  line  is  changed,  bringing  the 
central  incisors  to  the  right  or  left  of  the  center  of  the  face. 

47.  Special  effort  should  always  be  made  to  preserve  all 
the  first,  or  six  year,  molars  until  the  twentieth  year  at  least, 
after  which  time  little  effect  is  noticed  on  the  facial  lines  from 
the  extraction  of  these  teeth. 

48.  Never  extract  any  of  the  six  anterior  teeth.  Proba- 
bly the  greatest  damage  is  done  by  the  extraction  of  out-stand- 
ing cuspids.  No  excuse  can  be  offered  for  this  and  it  is  de- 
plorable to  sec  how  many  cases  are  ruined  by  such  blunders. 
It  is  absolutely  necessary  that  the  cuspids  should  both  be  in 
position  to  hold  the  proper  fullness  from  the  corners  of  the 
mouth  to  the  ala  of  the  nose.  When  these  teeth  are  extracted 
the  prominence  of  the  canine  eminence  is  lost  by  absorption, 
causing  a  sunken  appearance  at  each  side  of  the  nose,  the  same 
as  when  a  full  upper  plate  is  worn,  figures  43  and  44  serve 
as  illustrations.       In   thes<    cases  the  cuspids  have  no  room  in 


1NJ  L'DH'IOrS   KXTRAi'TKiX. 


37 


the  arch  but  instead  of  extracting  the  cuspids,  the  first  bicus- 
pids should  always  be  extracted,  and  the  cuspids  moved  into 
the  positions  of  the  extracted  teeth.     This  gives  proper  occlu- 

Fig.  43- 


sion  to  the  cuspids,  with  proper  prominence  to  the  lip ;  cor- 
recting  the   condition    without    marring   the   facial   lines.     In 

Fig.  44- 


each  of  these  cases  the  upper  lip  was  rather  too  prominent,  so 
extraction  of  some  teeth  was  necessary. 

49.  In  the  case  shown  in  Fig.  45,  the  same  condition  ex- 
ists to  some  extent,  but  the  upper  lip  is  not  unduly  prominent, 
and  the  occlusion  of  the  molars  and  bicuspids  is  normal.     In 


38 


ORTHODONTIA. 


a  case  of  this  kind  the  four  incisors  should  he  moved  forward 
to  give  room  for  the  cuspids  and  no  extraction  resorted  to.  If 
one  cuspid  is  extracted  and  the  remaining  teeth  moved  into 
line  the  patient's  expression  is  ruined  irreparably,  as  the  center 
line  is  changed  and  one  side  of  the  lip  sinks  in. 

50.  In  cases  like  that  shown  in  Fig.  46,  where  one  cuspid 
is  in  position  and  the  other  crowded  out  for  lack  of  room,  the 
center  line  must  always  be  carefully  noted  and  when  the  bicus- 
pids of  both  sides  occlude  normally  it  will  be  found  that  a  line 
drawn  between  the  central  incisors  will  be  to  the  right  or  left 

Fie-  45- 


ol  the  center  of  the  face,  accordingly  as  the  out-standing  cuspid 
is  the  right  or  left  cuspid.  In  the  case  shown  the  right  cuspid 
1-  oul  of  position  and  the  center  line  is  to  the  right  of  the  cen- 
ter  of  the  fare.  The  incisor  teeth,  therefore,  should  be  moved 
forward  and  swung  to  the  left  and  the  cuspid  placed  in  position 
as  shown  in  Fig.  47.  This  corrects  the  center  line,  gives  proper 
prominence  to  the  lips,  and  completes  the  arch. 

51.  I  pper  centrals  or  laterals  should  never  be  extracted. 
Whenever  they  viand  inside  the  line  of  the  arch  or  on  the  lin- 
gual side  of  the  cuspids,  as  in  Fig.  44.  which  is  so  often  the 


INJUDICIOUS  EXTRACTION.  39 

case  with  the  laterals,  by  carefully  considering  the  four  points, 
as  outlined  in  Paragraph  2,  they  can  always  be  placed  in  their 
proper  positions  if  the  case  is  undertaken  at  the  proper  age. 

Fig.  46. 


52.     Regarding  the  lower  four  incisor  teeth  :  as  these  teeth 
are  all  of  nearly  the  same  width  the  extraction  of  one  of  them 

Fig.  47- 


will  not  result  in  as  great  facial  disfigurement.     In  some  cases 
where  the  upper  arch  is  perfect  and  one  of  the  lower  incisors 


40  ORTHODONTIA. 

stands  inside  or  outside  the  arch,  or  these  teeth  are  out  of  line 
with  each  other,  so  that  by  sacrificing  one  the  others  may  be 
placed  in  line  and  complete  the  arch,  this  may  be  done,  after 
careful  consideration. 


SUPERNUMERARY    TEETH. 


41 


CHAPTER  III. 


SUPERNUMERARY    TEETH. 


53.  Supernumerary  teeth  erupt  at  about  the  time  the  per- 
manent set  appear  and  generally  occupy  a  position  near,  or  in 
the  place  of,  the  teeth  to  which  they  correspond,  causing  the 
permanent  teeth  to  be  displaced.  They  most  often  appear  in 
the  region  of  the  upper  incisors  and  are  generally  of  abnormal 

Fig.  48. 


shape,  with  conical  or  irregularly  formed  crowns.  In  some 
cases,  however,  their  shape  is  so  perfect  that  it  is  extremely 
difficult  to  decide  which  is  the  supernumerary  tooth.  These 
teeth  should  be  recognized  as  early  as  possible  and  extracted. 
By  so  doing  extensive  irregularities  are  intercepted.  They 
generally  erupt  inside  the  line  of  the  arch,  but  sometimes  take 
a  position  in  the  arch,  enlarging  it  and  crowding  the  other  teeth 
out  of  their  normal  positions. 


4^ 


ORTHODONTIA. 


54.  Fig.  48  shows  a  conically  crowned  supernumerary 
tooth  between  the  central  incisors.  The  patient  in  this  case 
was  twenty  years  old.    The  arch  was  abnormally  large,  caus- 

Fig.  49. 


ing  disfigurement  of  the  features.  If  this  tooth  had  been  ex- 
tracted when  it  first  appeared  this  condition  would  have  been 
avoided,  and  this  example  illustrates  how  so  small  an  opera- 

Fie.  =;o. 


linn  as  the  extraction  of  one  tooth,  at  the  proper  time,  would 
a   \  er\   <  xtensive  operation. 


SUPERNUMERARY    TEETH.  43 

55.  Fig.  49  is  the  case  of  a  girl  twelve  years  old.  Two 
perfectly  formed  laterals  occupied  the  space  between  the  cen- 
tral and  first  bicuspid,  causing  the  cuspid  to  erupt  outside  the 

Fier.  ;i. 


arch.  The  two  teeth  were  equally  well  formed,  so  the  distal 
one  was  extracted  and  the  cuspid  moved  into  the  arch.  If  this 
lateral  had  been  extracted  at  about  the  sixth  year  it  is  very 

Fig.  52. 


probable  that  the  cuspid  would  have  taken  its  normal  position 
without  assistance. 

56.     Fig.  50  shows  a  case  where  the  six  anterior  teeth  are 
out  of  line,  all  closing  inside  the  lower  arch  except  the  left  cen- 


44 


ORTIICDONT1A. 


tral.  Two  supernumerary  laterals  occupy  a  position  to  the 
lingual  of  the  permanent  laterals.  These  teeth  were  all  so  per- 
fect that  there  could  be  no  choice,  as  to  form,  regarding-  the 
better  ones  to  leave  in  the  mouth.  Those  which  stood  distally 
were  extracted,  as  the  others  were  nearer  the  line  of  the  arch. 

57.  Fig.  51  shows  a  supernumerary  tooth  with  an  irregu- 
larly shaped  crown  erupting  in  the  position  of  the  left  central. 
The  patient  was  seven  years  old.  This  tooth  was  immediately 
extracted  and  the  case  dismissed,  in  the  hope  that  the  perma- 

Fig-  53- 


nent  central  would  take  its  normal  position,  but  after  some 
time  there  was  no  improvement  and  an  appliance  was  used  to 
move  the  tooth  into  position. 

58.  Fig.  52  shows  to  what  extent  the  anterior  teeth  may 
be  displaced  by  the  two  small  supernumerary  teeth  which  have 
erupted  between  the  central  incisors.  As  these  teeth  appear 
at  about  the  same  time  the  centrals  erupt,  if  they  had  been  im- 
mediately extracted  and  the  centrals  moved  to  their  proper 
positions  if  necessary,  the  displacement  of  the  laterals  would 
have  been  prevented. 

59.  In  Fig.  53  the  righl  central  had  been  crowded  to  the 
left   nearly  its  width  by  a  supernumerary  which  had  erupted 


SUPERNUMERARY    TEETH.  45 

between  it  and  the  lateral,  on  the  lingual  side  of  the  arch. 
A  second  supernumerary  came  in  between  the  left  lateral  and 
right  central  and  the  central  on  this  side  was  still  imbedded  in 
the  process.  In  a  case  like  this  both  supernumeraries  should 
be  immediately  extracted  and  the  right  central  moved  until  in 
contact  with  the  right  lateral.  The  left  central  will  then  be 
free  to  take  its  proper  position  without  assistance.  After  this 
tooth  is  in  position  the  left  cuspid  and  lateral  should  be  drawn 
into  the  arch  and  to  the  right  until  the  anterior  teeth  are  all  in 
contact,  as  these  teeth  had  been  crowded  to  the  left  by  the 
supernumerary  on  that  side. 


46 


ORTHODONTIA. 


CHAPTER  IV 


ACE  AT  WHICH   CORRECTION   CAN  15EST   BE  ACCOMPLISHED. 


60.  The  nature  of  the  irregularity  determines  the  time 
correction  can  best  be  accomplished,  but  it  is  safe  to  say  that 
all  cases  should  be  completed  before  the  sixteenth  year  and 
that  every  case  should  be  regulated  just  as  early  as  possible. 
When  this  is  done  the  cases  are  easily  corrected  and  the  cor- 

Fis:.  54. 


rection  is  permanent.  In  main-  cases  a  few  days'  time  will 
correct  a  condition  at  six  or  seven  years  of  age,  where  if  the 
condition  is  allowed  to  exist  until  the  twelfth  year,  several 
months  will  be  required  to  correct  the  resulting  irregularity. 
\  case  of  this  kind  i>  shown  in  Fig.  54. 

1  [ere  the  central  is  rotated,  the  long  axis  of  the  tooth  stand- 
ing anterior-posteriorly,  causing  the  tooth  to  take  up  less  room 

in  the  arch  than  it  would  if  in  its  normal  position.      It  is  a  sim- 


AGE   FOR  CORRECTION. 


47 


pic  matter  to  rotate  this  tooth  at  this  age,  which  is  about  eight 
years,  while  at  the  age  of  twelve  or  thirteen  the  adjacent  teeth 
would  all  have  moved  forward  until  in  contact  with  the  mal- 

Fig.  55- 


posed  tooth.  This  would  make  it  necessary  to  move  at  least 
all  the  other  five  anterior  teeth  to  make  room  for  this  central, 
which  would  consume  several  months  at  least. 

Fig.  56. 


61.  Fig.  55  shows  a  case  where  the  upper  left  central  is 
inlocked.  Such  cases  should  be  corrected  immediately,  even 
before  the  tooth  is  fully  erupted.  As  these  teeth  erupt  at 
about  the  fifth  or  sixth  year  this  form  of  irregularity  is  the  first 
to  appear.     When  both  centrals  strike  inside  the  lower  and  the 


48  ORTHODONTIA. 

condition  is  not  immediately  corrected,  it  results  as  shown  in 
Fig.  56.  A  week's  treatment  at  the  proper  age,  about  the 
sixth  year,  would  have  prevented  the  resulting  deformity.  The 
models  shown  in  Fig.  56  were  made  from  impressions  taken  at 
the  age  of  twelve  years. 

62.  Fig.  57  shows  a  case  where  the  right  central  bites  in- 
side the  lowers,  with  appliance  in  position  to  move  it  out  of 
inlock,  before  the  right  lateral  has  erupted.  After  the  tooth  is 
in  line  the  appliance  is  left  in  position  to  retain  it  while  the 
lateral  comes  into  place. 

Fig-  57- 


63.  Where  spaces  intervene  between  the  teeth,  as  shown 
in  Fig.  58,  the  condition  should  be  corrected  as  soon  as  the  cen- 
trals and  laterals  are  in  position,  which  is  about  the  eighth 
year.  The  laterals  should  be  banded  and  the  teeth  drawn 
together  until  they  are  in  close  contact.  A  retaining  appliance 
should  be  put  on  to  hold  them,  and  worn  for  a  year. 

64.  Where  the  four  lower  incisors  slightly  over-lap  each 
other,  as  is  so  often  the  case,  no  correction  is  necessary,  for 
these  teeth  will,  in  nearly  all  cases,  take  their  proper  positions 
as  the  jaw  develops  and  increases  in  size. 

65.  The  author  has  never  seen  a  case  where  it  was  neces- 
sary to  wait  until  all  the  teeth  wen-  in  position  before  correc- 


AGK   FOR   COKKKCTION. 


49 


tion  should  be  begun.  Of  course  the  three  molars  are  not 
taken  into  consideration.  The  cuspids  are  generally  the  last 
teeth  to  erupt,  and  whenever  there  is  not  sufficient  room  for 
these  teeth  space  should  be  gained  and  held  between  the 
laterals  and  first  bicuspids  to  accommodate  them.  When  this 
is  done  it  is  seldom  necessary  to  interfere  with  the  cuspids  as 
they  will  take  their  normal  positions  without  assistance,  and  a 
much  better  formed  arch  is  the  result. 

66.     Also,  when  the  upper  arch  is  contracted  and  the  buc- 
cal cusps  of  the  upper  bicuspids  and  molars  strike  lingually 

Fig.  58. 


to  the  buccal  cusps  of  the  lower  teeth,  the  condition  should  be 
corrected  as  soon  as  it  appears,  which  may  be  two  years  be- 
fore the  permanent  cuspids  take  their  position  in  the  arch. 

67.  The  author  has  had  excellent  results  in  cases  of  pro- 
truding upper  teeth  where  the  condition  was  plainly  evident  at 
the  age  of  eight  years,  by  extracting  the  upper  first  bicuspids 
as  soon  as  they  appeared  and  moving  the  six  anterior  teeth 
(which  includes  the  temporary  cuspids)  back  until  in  contact 
with  the  second  temporary  molars.  A  case  of  this  class  is 
shown  in  Fig.  16.  Fig.  17  shows  the  case  a  year  after  the 
operation. 


50  ORTHODONTIA. 

The  importance  of  early  intervention  in  cases  of  dental 
irregularities  cannot  be  too  strongly  emphasized,  as  the  opera- 
tion can  be  performed  with  much  less  work,  simpler  appliances, 
and  it  is  not  necessary  for  the  patient  to  wear  the  retaining 
appliance  as  long  to  insure  permanent  results. 


TOOTH  MOVEMENT. 


CHAPTER  V. 

TOOTH    MOVEMENT  :      THE   DISTANCE   TEETH    MAY    BE 
SAFELY    MOVED  IN    TWENTY-FOUR    HOURS. 


68.  The  distance  a  tooth  should  be  moved  in  twenty-four 
hours  depends  entirely  on  the  age  of  the  patient  and  the  direc- 
tion in  which  the  tooth  is  moved.  A  central  incisor  can  be 
moved  directly  forward  more  rapidly  than  directly  backward, 
while  much  less  movement  in  twenty-four  hours  is  permissible 

Fig-  59- 


if  the  tooth  is  being  moved  laterally  through  the  alveolar 
process  than  when  moving  it  forward  or  backward.  Also, 
bicuspids  and  molars  can  be  moved  labially  or  lingually  much 
more  rapidly,  without  damage,  than  anteriorly  or  posteriorly. 
The  old  adage,  "Haste  makes  waste,"  can  be  most  aptly  ap- 
plied to  teeth  regulation. 

If  teeth  be  moved  a  certain  distance  at  certain  intervals 
and  the  gain  unflinchingly  maintained  (as  is  possible  with  this 


5- 


ORTHODOXTIA. 


system  where  means  are  afforded  to  securely  lock  every  appli- 
ance), it  results  in  physiological  absorption  of  the  alveolar 
process,  new  tooth  position,  and  restoration  of  the  process  to 
sustain  it.  Positive  movement  securely  maintained,  a  period 
of  rest,  and  timely  repetitions  of  the  process  are  the  sources 
of  success  in  teeth  regulation. 

Also,  too  rapid  movement  of  teeth  must  be  carefully 
guarded  against,  for  the  slower  teeth  are  moved,  the  more 
permanent  are  their  new  positions.  Operators  who  tighten 
appliances  to  the  extreme  limit,  hoping  to  get  the  work  done  in 

Fief.  60. 


the  shortest  possible  time,  cause  unnecessary  pain,  many  times 
actual  damage,  and  seldom,  if  ever,  complete  their  cases.  Tain 
or  soreness  indicate  that  the  teeth  are  being  moved  too  rapidly. 
When  these  conditions  appear  either  the  appliances  should 
not  be  tightened  as  much  a^  usual,  or  the  intervals  between 
tightening  should  be  lengthened.  Teeth  will  be  moved  with- 
out pain  or  soreness  when  the  operation  is  carried  on  physio- 
logically. Tain  indicates  inflammation,  which  is  a  patholoj 
condition,  and  this  i>  always  liable  to  resull  in  permanent  in- 
jury to  the  future  usefulness  of  the  organs  involved. 


TOOTH   MOVEMENT.  53 

Too  great  a  force  exerted  on  a  tooth  is  liable  to  strangulate 
the  pulp,  resulting  in  the  death  of  this  organ.  It  may  also 
cause  the  death  of  the  peridental  membrane.  When  this  oc- 
curs, if  the  pressure  is  not  immediately  relieved  and  proper 
treatment  resorted  to,  the  loss  of  the  tooth  is  the  result.  When 
teeth  are  moved  too  rapidly  they  are  liable  to  be  elongated. 

69.  In  a  case  with  an  inlocked  central,  as  shown  in  Fig. 
59,  if  the  age  of  the  patient  is  from  six  to  eight  the  tooth  may 
be  safely  moved  or  tipped  forward  one-fiftieth  of  an  inch  in 
twenty-four  hours.  If  the  patient  is  sixteen,  one  one-hundred- 
and-fiftieth  of  an  inch  is  the  limit  for  twenty-four  hours,  while 
at  twenty  the  amount  of  movement  should  be  reduced  to  one 
two-hundredth  inch. 

If,  however,  a  central  is  to  be  moved  in  the  opposite  di- 
rection, as  shown  in  Fig.  60,  the  amount  of  movement  should 
be  reduced  to  one  one-hundredth  of  an  inch  at  the  age  of  six 
or  eight,  with  corresponding  reductions  as  the  age  of  the  pa- 
tient increases.  This  is  necessary,  for  the  backward  move- 
ment of  an  incisor  requires  more  absorption  of  the  alveolar 
process,  necessarily  consuming  more  time  than  when  the  tooth 
is  moved  forward.  When  an  incisor  is  moved  forward  the 
shape  of  the  alveolar  process  permits  it  to  be  bent,  requiring 
very  little  actual  absorption. 

At  the  age  of  twenty,  a  tooth,  as  shown  in  Fig.  60,  should 
be  moved  only  from  one  three-hundredth  to  one  two-hundred- 
and-fiftieth  of  an  inch  in  twenty-four  hours. 

70.  When  the  incisor  teeth  are  to  be  moved  forward  and 
also  laterally  to  some  extent,  to  change  the  center  line  and  give 
room  for  the  cuspid,  as  in  the  case  shown  in  Fig.  61,  the  move- 
ment at  the  age  of  sixteen  should  be  one  four-hundred-and- 
fiftieth  of  an  inch  every  twenty-four  hours,  while  at  twenty  it 
should  be  one  six-hundredth  of  an  inch. 


54 


ORTHODONTIA. 


To  move  the  teeth  forward  and  to  the  left  and  place  the 
cuspid  in  line,  as  shown  in  Fig.  62.  should  consume  about  six 
months'  time.     If  the  appliances  are  tightened  every  other  day 

Fie.  61. 


w  i^'.^i 

WHm 

Kl£ 

,  i\  1 

W  *  A 

r 

jfn 

-.   ^ 

the  amount  of  movement  at  each  tightening  would  be,  there- 
fore, one  three-hundredth  of  an  inch,  and  if  they  are  tightened 

Fie.  62. 


~^F^WH 

V^> 

!^43ri  ^-f'^^H 

m  '■■■  n 

HF-al 

r       1 

twice  a  week  it  should  be  one  two-hundredth  each  time.  If 
the  teeth  move  withoul  any  soreness  the  amount  the  appliance 
is  tightened  can  be  increased,  as  the  ease  with  which  teeth 
varies  in  different  cases.  Sometimes  an  appliance  may 
be  tightened  one  full  revolution  of  the  nut,  which  is  one  one- 


TOOTH   MOVEMENT.  55 

hundredth  of  an  inch,  three  times  a  week.  This  is  more  often 
the  case  with  patients  from  twelve  to  sixteen.  The  teeth 
would  then  be  moving  one  three-hundredth  of  an  inch  a  day, 
and  this  would  be  permissible  only  when  the  teeth  move  with- 
out any  soreness  whatever. 

Fig.  63. 


71.  Cuspids  to  be  moved  backward  and  into  the  arch  may 
be  moved  one  two-hundredth  of  an  inch  in  twenty-four  hours 
at  the  age  of  fourteen,  while  at  the  age  of  twenty  one  six-hun- 
dredth is  the  proper  amount. 

72.  When  the  arch  is  to  be  expanded  in  the  region  of  the 
bicuspids  and  molars,  as  shown  in  Fig.  63,  and  the  patient  is 
not  over  sixteen,  one  two-hundredth  of  an  inch  in  twenty-four 
hours  will  be  found  to  be  about  the  proper  amount  to  tighten 
the  appliance.  It  could,  therefore,  be  expanded  one  one-hun- 
dredth of  an  inch  every  other  day.  To  move  the  appliance  one 
one-hundredth  inch,  the  long  nut  at  the  center  of  the  jack- 
screw  is  turned  one-half  a  revolution. 

73.  In  cases  of  arch  expansion  the  appliance  may  be  tight- 
ened excessively  without  damage  to  the  teeth,  as  the  superior 
maxillary  bones,  before  the  age  of  twenty,  will  separate  before 


c6  ORTHODONTIA. 

the  tooth  pulp  could  be  strangulated  or  the  peridental  mem- 
brane injured.  The  separation  of  the  superior  maxillary  bones 
will  be  indicated  by  the  increased  space  between  the  central 
incisors.  Expansion  may  be  continued  without  injury  until 
this  space  between  the  centrals  is  about  one-sixteenth  of  an 
inch  wide,  when  the  teeth  must  be  held  at  absolute  rest  for  one 
or  two  months  to  permit  new  bone  to  grow  between  the  separ- 
ated superior  maxillary  bones  and  unite  them.  The  space  be- 
tween the  centrals  will  generally  close  without  assistance. 

74.  In  protrusion  cases  where  the  first  bicuspids  have 
been  extracted  and  the  six  anterior  teeth  are  moved  back  until 
the  spaces  between  the  cuspids  and  second  bicuspids  are  closed, 
it  will  be  found  that  these  cases  move  at  a  rate  of  about  one 
five-hundredth  of  an  inch  in  twenty-four  hours,  if  the  head  cap 
is  worn  faithfully.  Protrusion  cases  will  average  from  four 
to  six  months  up  to  sixteen  years  of  age,  and  from  six  to  nine 
months  from  sixteen  to  twenty. 


author's  appliances.  57 


CHAPTER   VI. 


AUTHOR  S   APPLIANCES. 


75.  The  object  of  these  appliances  is  to  do  away  with  the 
necessity  of  soldering,  as  the  time  consumed  in  soldering  to- 
gether the  appliances  which  have  hitherto  been  used  is  much 
greater  than  the  actual  time  required  to  regulate  the  case,  so 

Fig.  64. 


that  when  means  are  offered  by  which  cases  can  be  corrected 
and  the  very  objectionable  feature  of  soldering  eliminated,  at 
least  two-thirds  of  the  labor  usually  connected  with  teeth  regu- 
lation is  avoided. 

After  a  long  series  of  experiments  in  practical  work  the 
author  has  succeeded  in  performing  all  the  operations  usually 
met  with  in  practice  by  means  of  the  different  combinations 
of  these  few  parts.  Each  part  is  complete  in  itself  and  all  parts 
are  interchangeable.  All  connections  are  made  by  either  screw 
attachments  or  interlocking  mechanism,  which  permit  them  at 
all  times  to  be  easily  removed  or  replaced.  Means  are  also 
offered  for  firmly  locking  the  appliances  during  the  intervals 
between  tightening1,  a  most  valuable  consideration,  and  a  fea- 


:S  ORTHODONTIA 

ture  not  found  in  any  other  system.  Another  advantage  pe- 
culiar to  this  system  is  the  special  construction  of  the  clutch 
tubes,  by  which  all  the  bars  are  permitted  to  pass  through  the 
sides  of  the  tubes,  making  it  unnecessary  at  any  time  to  re- 
move the  nuts  from  the  bars  or  to  remove  the  bands  in  order 
to  take  the  appliance  from  the  mouth.  There  are  but  twenty- 
Fig.  65. 


five  necessary  parts,  the  different  combinations  of  which  form 
all  the  appliances  described  in  this  work.  Several  other  parts 
are  added  for  the  sake  of  convenience,  although  the  operations 
may  be  performed  entirely  without  the  assistance  of  these 
parts.  For  example,  the  bar-end  cap,  Xo.  34,  does  not  form  an 
1  ssential  pan  of  any  appliance,  but  serves  to  protect  the  soft 

Fig.  66. 


tissues  "i  the  mouth  from  irritation  by  the  projecting  ends  of 
the  threaded  bars.  Again,  the  perforated  stud,  No.  30,  forms 
a  convenienl  means  for  attaching  the  end  of  the  jack-screw  to 
the  buttons  of  a  band  with  band  wire,  although  this  connection 

can  be  made  by  simply  attaching  the  wire  to  the  T  head  of  the 
left   hand  'I    liar.   No.  40.  and  this  allaehinent   is  sometimes  pre- 


AUTHOR  S  APPLIANCES.  59 

ferred,  as  shown  in  several  illustrations.  A  brief  description 
of  the  several  parts  will  serve  to  familiarize  the  operator  with 
their  forms  and  uses.  Each  part  has  an  indicative  number 
by  which  it  may  be  identified  in  description  and  illustration. 

76.  Three  forms  of  bands  are  used  for  attaching  the  dif- 
ferent combinations  to  the  teeth  :  studded  bands,  as  shown  in 
Fig.  64,  bands  with  a  single  socket  clutch  tube,  shown  in  big. 

65,  and  those  with  the  double  socket  clutch  tube,  shown  in  Fig. 

66.  The  three  forms  of  bands  arc  made  with  both  button  and 
screw  attachments. 

Fig.  67. 

77.  Fig.  64  shows  a  studded  button  band  with  the  buttons 
connected  by  band  wire  No.  30.  Fig.  67  is  the  plane  projec- 
tion of  the  same  band,  more  enlarged,  showing  the  relative 
positions  of  the  buttons  and  threaded  stud. 


Fie.  68. 


5 


■■■■■■■■■ ■■-*  ■W^HMMBt, 

These  bands  are  made  in  seven  sizes  and  numbered  from 
one  to  six  inclusive.  Fig.  68  gives  the  exact  lengths  of  the 
bands  with  the  number  of  each.  The  threaded  stud,  which  is 
attached  to  the  center  of  each  of  these  bands,  affords  attach- 
ment for  the  ball  cap  No.  24,  retaining  clamp  nut  No.  38,  and 
stud  bar  nut  No.  54. 

The  studded  button  bands  are  used  on  all  teeth  except  mo- 
lars. They  form  attachment  for  the  moving  end  of  the  appli- 
ance. The  band  No.  1  is  the  smallest  and  No.  6  the  largest. 
Band  No.   1  is  of  a  size  suitable  to  be  used  on  lower  central 


Oo 


ORTHODONTIA. 


incisors  and  abnormally  small  laterals  (called  pin  or  peg  teeth). 
Xo.  2  is  for  lower  centrals  and  laterals  and  small  upper  laterals. 
Xo.  3  is  the  size  generally  used  on  upper  lateral  incisors,  al- 
though for  very  large  laterals  Xo.  4  may  be  required.  The  No. 
4  band  is  the  size  most  used  on  lower  first  bicuspids  and  cus- 
pids ;  also  on  small  upper  centrals.  Small  bicuspid  teeth  require 
the  Xo.  5  band,  medium  sized  bicuspids  the  No.  $y2,  and  the 
larger  bicuspids  require  the  Xo.  6. 

Fig.  69. 


78.  It  will  be  observed  that  through  the  agency  of  the 
buttons  and  the  band  wire  the  size  of  each  band  is  adjustable 
and  the  same  size  band  may  be  used  on  either  a  tooth  which 
would  permit  the  buttons  to  come  so  close  together  as  to  be 
in  contact  (see  Fig.  69),  or  on  a  larger  tooth  where  the  but- 
big.  70. 


tons  would  be  so  far  apart  that  each  button  would  be  in  contact 
with  the  adjacenl  tooth.  Sec  Fig.  70.  Thus  each  band  has 
a  wide  range,  and  il  is  possible  to  have  at  band  ready-made 
band-  applicable  t"  all  teeth,  saving  the  operator  the  trouble 
of  soldering  band-  and  attachments. 

Both  the  studs  and  buttons  of  these  bands  afford  excellent 
attachmenl  for  silk  or  rubber  ligatures,  win-  connections,  etc. 


author's  appliances.  6i 

79.  Four  lengths  of  studded  bands  are  made  with  screw 
attachment,  numbered  41  to  44  inclusive.  Their  lengths  and 
numbers  are  given  in  Fig.  71.  These  bands  can  be  used  on 
an}-  of  the  teeth  anterior  to  the  molars,  the  same  as  the  bands 

Fig.  71. 


143 
144 


shown  in  Fig.  68.  The  shortest  length.  No.  41,  is  the  same 
length  as  Xo.  3.  Fig.  68.  As  it  is  not  practical,  bands  with 
screw  attachment  are  not  made  shorter  than  the  No.  41. 

Bands  with  screw  attachment  are  very  convenient  for  use 
on  bicuspids  and  molars,  but  it  is  generally  preferable  to  use 
the  button  bands  on  the  six  anterior  teeth,  owing  to  the  shape 
of  the  crowns  of  the  teeth. 

Fig.  72. 


|65 


a       *      -a  65  - 


80.  In  Fig.  72  will  be  seen  a  set  of  button  studded  bands 
of  the  same  lengths  as  those  shown  in  Fig.  68,  but  these  bands 
have  an  extra  long  stud,  its  length  being  one-quarter  of  an 
inch.  These  bands  are  numbered  61  to  66  inclusive.  No.  61 
is  the  same  length  as  No.  1,  Fig.  68,  No.  62  the  same  length 
as  No.  2,  and  so  on  throughout  the  list. 


62 


ORTHODONTIA. 

TO  APPLY  THE  BANDS. 


81.  First  select  a  band  of  the  proper  size,  attach  to  one 
button  a  piece  of  band  wire  in  the  manner  shown  in  Fig  73,  and 
carefully  work  the  band  around  the  tooth  to  be  banded.  Do  not 
use  a  mallet  or  pound  on  the  band.  If  the  teeth  are  very  tight 
together  press  a  thin  spatula  or  a  piece  of  thin  German  silver 

Fig.  73- 


a 


^E§**» 


between  them  on  each  side,  let  it  remain  a  few  minutes,  and 
when  removed  the  band  will  go  between  the  teeth  easily.  Bur- 
nish the  band  to  fit  the  irregularities  of  the  tooth  surface,  pass 

Fig-  74- 


the  wire  under  the  other  button,  as  shown  in  Fig.  74,  and  draw 
it  tightly  around  the  button,  as  shown  in  Fig.  75.  Then  re- 
move the  wire  from  this  button,  being  careful  to  leave  the  kink 

Fig.  75- 


;n  the  wire  where  it  passed  around  the  button,  shown  at  K,  Fig. 
70.  This  will  be  a  gauge  to  the  size  of  the  tooth  after  the  band 
is  removed.      Next  remove  the  band  from  the  tooth  and  replace 


author's  appliances.  63 

the  wire  around  the  button,  giving  it  two  or  three  cross  turns 
in  the  form  of  a  figure  eight  around  both  buttons,  ending  in  one 
or  two  turns  of  the  wire  around  the  center  of  the  coil,  as  shown 

Fig.  76. 


in  Fig.  77.     The  band  is  then  ready  to  be  cemented  to  the  tooth. 

82.     A  coil  of  the  band  wire  No.  30  used  in  connecting  the 

buttons  of  these  bands,  is  shown  in  Fig.  78.     It  is  exceedingly 

Fig.  77. 


flexible  and  tough,  and  will  stretch  before  it  will  break.     The 
tough  metal  center  is  covered  with  two  coatings  of  gold. 

83.     A  band  wired  in  this  way  has  some  decided  advan- 

Fig.  78. 


tages  over  a  soldered  band,  as  it  will  adapt  itself  to  the  contour 
of  the  tooth  in  a  manner  which  is  impossible  with  a  soldered 
band.  An  illustration  of  this  is  shown  in  Figures  79  and  80. 
Fig.  79  shows  a  band  passing  over  the  crown  of  a  tooth.  After 
it  has  passed  the  bulge  it  adapts   itself  to  the  shape  of  the 


(  »4  ORTHODONTIA. 

tooth,  coming  closely  in  contact  with  the  tooth  at  the  inter- 
dental space.  In  Fig.  79  the  diameter  of  the  band  at  A  is  less 
than  at  B.  In  Fig.  80  the  condition  is  exactly  reversed,  the 
diameter  at  B  being-  less  than  at  A.     This  is  not  possible  with 

Fig".  79. 

~A. 


a  -olid-collar  band,  which  all  soldered  bands  are.  Fig.  81 
shows  the  position  of  a  solid  band  on  a  tooth.  If  this  band  is 
pressed  close  to  the  tooth  at  the  interdental  space  it  must  bulge 

Fiff.  80. 


out  some  other  place  the  same  amount  it  is  pressed  in  at  the 
interdental  space. 

When  bands  arc  wired,  as  shown  in  Figures  70  and  So.  the 
wire-  forms  a  swivel  connection,  permitting  the  hand  to  increase 
in  size  at  .\  when  diminished  at  1'.  exactly  conforming  to  the 
contour  of  the  crown  of  the  tooth.  When  a  band  is  cemented 
to  ;i  tooth  in  this  position  it  i^  practically  impossible  to  dis- 
lodge it   until  the  wire-  are  cut. 


author's  appliances.  65 

84.  As  the  single  socket  clutch  tube  bands  Xos.  11  to  14 
inclusive,  and  the  double  socket  clutch  tube  bands  Xos.  7  to  10 
inclusive,  have  button  attachments,  they  are  wired  in  the  same 
manner.  All  button  bands  should  be  cemented  to  the  teeth, 
and  do  not  loosen  when  this  is  properly  done. 

85.  To  cement  a  band  to  a  tooth,  a  napkin  or  absorbent 
cotton  roll  should  be  placed  in  the  mouth  to  protect  the  tooth 
from  moisture,  the  tooth  wiped  dry  with  a  piece  of  absorbent 

Fie-.  Si. 


\POCA£r 


cotton  and  its  entire  surface  and  the  inside  of  the  band 
thoroughly  dried  with  alcohol.  A  good  cement  should  then 
be  mixed  to  a  sticky  consistency  and  applied  to  the  entire  inner 
surface  of  the  band  and  to  the  surface  of  the  tooth.  If  the 
tooth  has  been  properly  dried  the  cement  will  adhere  to  the 
entire  surface.  The  band  should  then  be  placed  over  the  tooth 
well  up  to  the  gum,  the  surplus  cement  partially  removed  and 
the  band  and  tooth  coated  with  sandarac  varnish. 

The  patient  should  be  instructed  to  not  bite  against  or 
touch  the  band  for  an  hour.  Xo  attachment  should  be  made 
for  three  hours,  and  it  is  much  better  to  allow  twenty-four 
hours  to  elapse  before  connecting  the  appliance.  Bands  thus 
cemented  to  the  teeth  will  not  loosen.  To  remove  them,  un- 
wind or  cut  the  wire  and  the  band  may  then  be  easily  taken 
from  the  most  sensitive  or  loose  tooth  without  injury  to  the 


oo 


ORTHODONTIA. 


tooth  or  band.     Each  band  can  be  used  on  a  number  of  cases, 
if  properly  cared  for. 

86.     Fig.  82  is  a  plane  projection  of  a  single  socket  button 
band,  the  same  as  shown  in  Fig.  65.     These  are  made  in  five 

Fie-.  82. 


& 


sizes,  numbered  from  11  to  14  inclusive;  they  have  button  at- 
tachments and  correspond  in  lengths  to  the  studded  bands, 
Xos.  3,  4.  5,  53/2  and  6.  Single  socket  bands  are  also  made  in 
the  same  lengths  with  screw  attachments.  They  are  num- 
bered 45  to  48  inclusive,  Xo.  45  having  the  same  length  as  No. 
II,  and  Xo.  48  the  same  length  as  Xo.  14.  .Appliances  are  at- 
tached to  these  bands  by  means  of  the  single  socket  clutch 
tube.  This  tube  is  firmly  fixed  to  the  band  and  has  a  recessed 
opening  at  one  end  for  the  reception  of  the  rounded  portion  of 
the  clutch  nut  Xo.  22.  This  serves  to  bold  any  of  the  bars  in 
the  clutch  tube  after  they  have  been  passed  through  the  slot 

Fig.  83. 


and  the  clutch  nut  turned  into  the  recessed  opening,  as  in  Fig. 
83.  These  bauds  arc  u>v<\  on  any  teeth  anterior  to  the  molars 
and  serve  both  as  attachment  for  the  moving  part  of  the  ap- 
pliance  and  to  assist  in  anchorage. 

87.     Fig.  84  gives  the  lengths  of  the  single  socket  button 
bands  with  their  corresponding  numbers,  and  Fig.  85  gives  the 


AUTHOR'S  Al'I'LIA.MT.S. 


67 


lengths  of  the  single  socket  bands  which  have  screw  attach- 
ments, with  their  numbers. 

88.     The    double    socket   clutch    bands   are   made    in   four 
lengths,   with   both    screw   and   button    attachments.     Fig.   86 


Fig.  84. 


in 
112 


ic_ 


»3 


i'3l 
114 


gives  the  lengths  and   numbers  of  those   with  button   attach- 
ments, and  Fig.  87  the  lengths  and  numbers  of  those  with  screw 


145 
146 


Fig.  85. 


(jJiWiHMmt 


147 


■  471 

148 


attachments.      The  bands  with  button  attachments  are  num- 
bered 7  to  10  inclusive,  and  those  with  screw  attachment  are 


19 

HO 


numbered  49  to  52  inclusive,  No.  49  corresponding  in  length 
to   No.  7  and   Xo.  52  to  No.   10.      These  bands  are  used   for 


68  ORTHODONTIA. 

anchorage,  the  clutch  tube  serving  for  the  attachment  of  the 
several  different  forms  of  appliance. 

Fie.  87. 


l4Q  ^HBiHiHHHlSI 

150  1MBHHMMMHHHHHHHM5:! 


89.  Fig.  88  is  an  enlarged  drawing  of  the  double  socket 
clutch  tube  of  the  molar  bands,  either  screw  or  button.  A  is 
the  band  to  which  the  partial  tube  B  is  attached.  Each  end 
of  the  tube  is  recessed,  shown  at  C,  to  receive  the  cylindrical 
ends  of  the  clutch  nuts  Xo.  22.  The  operation  of  placing  a 
threaded  bar  in  position  in  a  clutch  tube  by  passing  it  through 
the  side  of  the  tube  is  illustrated  in  Fig.  89.  A  represents  the 
hand,  15  the  clutch  tube,  G  G  indicate  the  threaded  bar,  and  F  F 
the  clutch  nuts  No.  22.  The  clutch  nuts  should  be  placed  on 
the  bar  with  their  cylindrical  portions  approaching  each  other, 
and  they  should  be  a  little  farther  apart  than  the  length  of  the 
clutch  tube.  Then  the  bar  with  nuts  in  position,  as  shown  at 
11.  may  be  passed  through  the  opening  of  the  clutch  tube  B. 
The  bar  is  held  in  position  in  the  clutch  tube  as  soon  as  the 
cylindrical  end  of  one  or  both  nuts  has  been  turned  into  the 

sed  end  of  the  tube  just  a  shorl  distance.  By  turning  the 
nuts  I'  F  tightly  into  the  tube,  as  shown  in  Fig  90,  the  bar  is 
clamped  (irmly  into  the  tube.  It  cannol  move  forward,  back- 
ward, or  laterally,  and  the  nuts  arc  also  locked  against  the 
tube  SO  they  cannot   become  loosened. 


A(    IIIOK'S    Al'l'l.l  Wl'KS. 


69 


Fisr. 


Fig.  89. 


Fig.  90. 


AUTHORS  APPLIANCES.  J  I 

It  will  thus  be  seen  that  the  clutch  tube  receives  and  holds 
firmly  the  anchorage  portions  of  all  the  devices  used  in  these 
appliances,  and  allows  them  to  be  easily  and  quickly  placed  in 
position,  and  removed,  without  taking  the  bands  from  the  teeth 
or  the  clutch  nuts  from  the  bars.  This  last  advantage  will  be 
duly  appreciated  by  every  dentist  who  has  attempted  to  place 
a  nut  on  a  bar  or  wire  after  passing  it  through  a  tube  or  pipe 
fixed  on  a  tooth  band  in  the  mouth.  He  will  well  remember 
his  efforts  to  put  nuts  on  traction  bars  or  wire  arch  bars  pro- 
truding from  the  distal  ends  of  tubes  on  molar  bands. 


Fig.  91. 


Fig.  92. 


90.  One  of  the  advantages  of  these  screw  bands  over  all 
other  forms  of  screw  bands  is  the  special  form  of  nut  and  collar 
used  in  connection  with  the  threaded  screw.  The  collar  is 
slotted  in  the  same  manner  as  the  clutch  tube.  This  permits 
the  threaded  bar  to  pass  laterally  through  the  side  of  the  col- 
lar. The  screw  band  nut  is  recessed  to  receive  the  projection 
on  the  collar,  so  that  when  the  projection  on  the  collar  enters 
the  recessed  portion  of  the  nut  the  nut.  collar,  and  threaded 
screw  are  held  firmly  in  their  relative  positions.  By  removing 
the  collar  from  the  nut  the  threaded  bar  may  be  passed  later- 


7- 


OUTIIODOXTIA. 


alh"  through  the  collar  and  the  band  straightened  ont.     Fig- 
ures 91,  92  and  93  illustrate  these  points. 

91.  In  Fig.  91  the  band  is  shown  with  the  nut,  collar  and 
screw  in  position  ready  for  the  band  to  be  clamped  to  a  tooth. 
In  Fig.  92  the  collar  is  slipped  backward  on  the  bar  so  that  the 

Fig-  93- 


projection  is  ont  of  the  recessed  opening  of  the  nut.  Fig.  93 
shows  the  band  with  the  collar  free  from  the  screw.  Fig.  94 
is  a  plane  projection  of  a  screw  band,  showing  two  sectional 
views  of  the  clutch  tube  and  collar. 


Fig-  94- 


"I 


£  *ij> 


92.     Another  advantageous   Feature  of  the  double  socket 
screw  bands  is  the  length  of  the  screw,  which  is  an  inch  long 

rind  threaded  so  that  all  the  mils  and  Other  parts  of  the  appli- 
ances which  lit  on  the  T  bars,  No.  [9  and  No.  20,  and  the  stud 
bar,  No.  53,  will  operate  equally  as  well  on  this  part.  The  use- 
fulness of  this  long  screw  is  illustrated  in  many  of  the  cast's 
hereafter  described. 


AUTHOR  S  APPLIANCES. 


73 


BITE  P.AXDS. 

93.  ^"hen  one  or  more  of  the  upper  six  anterior  teeth  bile 
inside  the  lower,  it  is  generally  necessary  to  open  the  bite  so 
the  inlocked  tooth  or  teeth  may  pass  over  the  lower  arch  with- 
out interference.  The  bite  bands,  numbered  15  to  18  inclusive, 
are  for  this  purpose.  Fig.  95  shows  the  bite  band  No.  18,  exact 
size.  This  is  the  size  used  on  the  lower  molars,  the  other 
three  sizes  are  for  the  lower  bicuspids. 

Fig-  95- 


15 
116 


117 

118 


94.  It  is  generally  advisable  to  place  bite  bands  on  the 
molars  if  possible.  While  in  short  operations  a  band  placed  on 
one  molar  is  sufficient,  it  is  better  to  have  one  on  a  molar  of 
each  side.  These  bands  are  wider  than  those  used  in  regulat- 
ing teeth  and  have  four  buttons,  two  of  which  are  attached 
at  one  end  and  the  other  two  at  some  distance  from  the  other 
end  of  the  band.  This  allows  the  extra  length  on  one  end  of 
the  band  to  pass  inside  the  other  end  and  close  the  otherwise 
open  space,  when  the  buttons  are  wired  together  with  band 
wire  Xo.  30.  This  makes  a  tight  collar  around  the  tooth  and 
when  filled  with  cement  and  amalgam  forms  a  temporary 
crown. 


74 


ORTHODONTIA. 


The  buttons  are  attached  nearer  to  one  edge  of  the  band 
than  the  other,  and  this  edge  should  be  placed  near  the  gum. 
The  upper  part  of  the  band  should  be  trimmed  off  with  shears 
if  the  band  is  too  wide  and  holds  the  teeth  too  far  apart. 

95.  To  place  these  bands  on  the  teeth  ;  tie  an  end  of  band 
wire  Xo.  30  to  the  button  nearest  the  end  and  edge  of  the  band ; 
next  curl  the  band,  with  the  long  end  inside,  until  it  is  a  little 
too  small  for  the  tooth  and  press  it  over  the  tooth  to  make  a 

Fig.  96. 


tight  fit.  If  the  extra  lap  of  band  should  be  too  long,  and  pass 
between  the  teeth,  causing  two  thicknesses  of  band  between 
the  teeth  on  one  side,  and  the  teeth  sin  mid  be  tight  together, 
cut  the  end  of  the  lap  off  enough  to  just  miss  going  between 
the  teeth. 

The  buttons  at  the  bottom  of  the  band,  near  the  gum, 
should  be  drawn  a  little  nearer  together  than  the  upper  ones. 
This  will  make  a  close  fit  around  the  neck-  of  the  tooth  and  form 
a  larger  grinding  surface  at  the  tup  of  the  band. 

When  the  band  is  in  position  both  sets  of  buttons  should 
be  wired,  the  lower  set  first,  and  a  napkin  or  cotton  roll  placed 
around  the  tooth.  The  crown  of  the  tooth  and  the  inside  of 
the  band  should  then  be  thoroughly  dried  with  alcohol.      Ce- 


AUTHOR  S  APPLIANCES. 


75 


merit  and  amalgam  should  then  be  prepared  (the  cement  mixed 
rather  thin),  the  band  filled  two-thirds  full  of  cement  and  the 
amalgam  immediately  placed  on  it  and  firm  pressure  brought 
to  bear  on  the  top  of  all.  This  will  force  the  cement  all  around 
the  crown  of  the  tooth  and  out  at  the  lower  edge  of  the  band. 
This  makes  a  very  solid  temporary  crown,  proof  against  decay, 

Fig.  97. 


and  may  be  left  on  any  length  of  time  with  no  fear  of  injury 
to  the  tooth;  which  cannot  well  be  done  with  a  soldered  band, 
as  it  is  difficult  to  make  a  proper  fit  at  the  neck  of  the  tooth, 
and  if  left  on  any  length  of  time  is  liable  to  cause  decay. 

The  amalgam  should  be  so  trimmed  that  the  teeth  will 
strike  evenly  on  each  side  when  two  bands  are  used.  A  sec- 
tional drawing  of  a  tooth  with  a  bite  band  in  position  is  shown 
in  Fig.  96.  A  indicates  the  tooth,  B  the  band,  C  the  cement 
and  D  the  amalgam.  A  bite  band  in  position  holding  the  jaws 
apart  is  shown  in  Fig.  97. 

To  remove  these  bands,  unwind  or  cut  the  wire,  strip  off 
the  band,  and  remove  the  amalgam  and  cement  with  a  scaler. 


7" 


ORTHODONTIA. 


CLUTCH  NUT  NO.  22. 

96.  The  clutch  nut  Xo.  22  is  right-hand  threaded  and 
used  on  all  right-hand  threaded  bars,  including-  the  screw  of 
the  screw  hands.  Fig.  98  shows  this  part  enlarged.  The 
squared  portion  is  for  the  operation  of  the  wrench  and  the 
smaller  rounded  portion  enters  the  recessed  ends  of  the  clutch 

Fig.  98. 


tubes,  holding  the  threaded  bars  in  the  tubes.  Fig.  99  shows 
a  sectional  view  of  the  nut.  Fig.  100  gives  the  same  view  with 
part  of  the  cylindrical  portion  cut  away  so  as  to  show  more 
plainly  the  detail  at  C  C.     This  extreme  end  of  the  nut,  which 

Fig.  99. 


Fig.  100. 


i-  \    shaped,  fits  into  the  corresponding  grooves  I)   1'  <>l  the 
clutch  tube  I'.,  Fig.  88.      This  point  is  also  shown  in  Fig.  101. 

Referring  again  to  Fig.  100,  the  squared  portion  of  the 
nut,  on  which  the  wrench  operates,  is  shown  at  A.  the  cylindri- 
cal portion  which  enters  the  recessed  opening.  (',  of  the  clutch 
tube  shown  in   Fig.  88,  is  shown  at   1'..     This  cylindrical  por- 


AUTHORS  APPLIANCES.  ~j~j 

lion  of  the  nut  is  slightly  longer  than  ihc  recessed  opening  <  . 
Fig.  88,  causing  the  pressure  of  the  nut  against  ihe  clutch  tube 
to  be  exerted  at  the  point  C  C,  Fig.  ioo,  which  fits  into  the 
groove  D,  Fig.  88.  This  prevents  the  squared  portion  of  the 
nut  from  coming  into  close  contact  with  the  end  of  the  tubej 
so  that  the  nut  always  works  smoothly  and  freely  in  the  clutch 
tube. 

97.  Two  nuts  must  always  be  used  in  operating  a 
threaded  bar  in  a  clutch  tube.  This  allows  the  bar  to  be  oper- 
ated equally  well  in  either  direction  and  to  be  firmly  locked 
in  the  tube  during  the  intervals  between  tightening.  This  is  a 
most  important  consideration   in  the  successful  movement  of 

teeth. 

Figf.  101. 


98.  In  Fig.  101  C  represents  the  clutch  tube  of  a  molar 
band,  A  and  B  the  clutch  nuts  No.  22,  and  D  D  a  portion  of  a 
threaded  bar.  When  the  nut  A  is  loosened  and  the  nut  B 
tightened  the  threaded  bar  D  D  will  be  moved  in  the  direction 
indicated  by  the  arrow  at  H.  When  the  nut  B  is  loosened  and 
the  nut  A  tightened  the  threaded  bar  will  travel  in  the  direc- 
tion indicated  by  the  arrow  at  E.  By  tightening  both  the  nuts 
A  and  B  firmly  against  the  clutch  tube  the  bar  D  D  is  locked  in 
the  tube  and  cannot  move  in  either  direction. 

99.  The  distance  a  tooth  is  moved  each  time  the  appliance 
is  tightened  can  be  easily  regulated  by  the  number  of  revolu- 
tions, or  fractions  of  a  revolution,  the  nuts  arc  turned.     One 


78 


ORTHODONTIA. 


full  revolution  of  the  nut  moves  the  appliance  one  one-hun- 
dredth of  an  inch.  In  Fig.  102  F  is  the  band  attached  to  a 
molar  tooth,  A  is  the  band  on  the  tooth  to  be  moved,  B  the 
threaded  bar  connecting  the  bands.  C  the  nut  at  the  anterior, 
and  D  the  nut  at  the  posterior  end  of  the  clutch  tube  of  the 
molar  band.  The  arrow  at  E  shows  the  direction  in  which 
the  threaded  bar  should  move  to  retract  the  tooth  A. 

Figf.  102. 


ico.  If  it  is  desired  to  retract  the  tooth  one  one-hun- 
dredth of  an  inch  the  nut  C  should  be  loosened  one  full  revolu- 
tion, this  unlocks  the  appliance  and  permits  the  bar  B  to  move 
back  through  the  clutch  tube  one  one-hundredth  of  an  inch 
when  the  nut  D  is  turned  forward  on  the  bar  one  full  revolu- 
tion. As  soon  as  the  nut  D  has  been  turned  one  revolution  the 
nut  C  will  be  drawn  into  the  clutch  tube  to  its  original  position. 
The  nut  13  should  be  turned  tightly  into  the  tube  and  the  ap- 
pliance is  again  locked.  If  it  is  desired  to  move  the  tooth  back 
one  two-hundredth  of  an  inch  the  nut  C  should  be  turned  for- 
ward <>ne-half  a  revolution  and  the  nut  D  turned  forward  a 
corresponding  amount.  It  will  thus  be  seen  that  if  the  nuts  are 
turned  one-quarter  of  a  revolution  tin-  appliance  is  moved  one 
four-hundredth  of  an  inch.  If  tin-  nuts  are  turned  one-half  a 
revolution  it  moves  one  two-hundredth  of  an  inch.  One  full 
revolution  moves  the  appliance  one  one-hundredth  of  an  inch 
and  two  revolutions  move  it  one-fiftieth  of  an  inch.  This 
should  always  be  kept   in  mind  and  the  appliance  should  be 


AUTHOR  S  APPLIANCES. 


79 


lightened  a  certain  amount  each  time.  This  amount  is  deter- 
mined by  the  age  of  the  patient,  the  direction  of  the  tooth 
movement,  and  the  stage  of  the  operation. 


COMPONENT  PARTS  OF  THE  JACK-SCREW. 

101.     The  parts  used  to  form  the  jack-screw  are  the  T  bars 
No.  20  and  Xo.  40,  ball  bars  Xos.  21.  33  and  57,  the  right  and 

Fig.  103. 


left  hand  threaded  nuts  Xos.  25  and  26,  the  ball  cap  Xo.  24, 
and  the  lock  nut  Xo.  27,.   Either  the  long  right  and  left  threaded 

Fig.  104. 


nut  No.  2?  or  the  short  right  and  left  threaded  nut  No.  26  forms 
the  central  part  of  the  jack-screw.     The  No.  25  is  five-eighths 

Fig.  105. 


of  an  inch  long  and  is  the  one  generally  used  in  making  up  the 
jack-screw.     The  No.  26  is  three-eighths  of  an  inch  long,  and 


8o 


ORTHODONTIA. 


is  used  when  the  distance  the  jack-screw  is  to  reach  is  too  short 
lor  the  use  of  the  No.  25.  The  short  nut  Xo.  26  is  always  used 
in  making-  up  a  jack-screw  for  arch  expansion. 

102.  Figure  103  is  an  enlarged  illustration  of  the  long  nut 
No.  25.  Fig.  104  is  a  sectional  view  of  the  same.  Fig.  105 
shows  the  Xo.  26  and  Fig.  106  gives  a  section  of  the  same  part. 
It  will  be  seen  that  the  nuts  Nos.  25  and  26  are  the  same  except 
in  length.  The  central  portion  of  each  is  squared  for  the  oper- 
ation of  the  wrench.  These  nuts  are  right-hand  threaded  at 
one  end  and  left-hand  threaded  at  the  other.  The  left-hand 
end  is  indicated  by  an  L  on  the  central  squared  portion  of  the 
nut.  This  should  always  be  observed  when  constructing  a 
jack-screw. 

Fig.  107. 


A*A»A<Ak«A'A<AVA'A'A'A<3M  KW^^V  '  \    ■Al'AUAkWAWAU. 


P> 


— ill    '•:!!        v  ,i,iv,,ls,,'-,v,v.1,  '  ,"" 


D 


^xxV^xxvxVvxxW 


A  DUMB  CI 

- —  u^^ 


103.  The  left-hand  threaded  bars  Nos.  21,  33  and  40  oper- 
ate in  the  left-hand  end  only.  The  right-hand  threaded  liars. 
Nos.  20  and  ^j,  operate  in  the  right-hand  end  only.  As  the 
parls  No.  [9  and  No.  53  and  the  screws  of  the  screw  hands 
an-  right-hand  threaded  and  of  the  same  diameter  they  will 
operate  in  the  right-hand  end  also.  The  threads  extend  in 
each  end  to  the  depth  of  aboul  one  sixteenth  inch,  the  central 
portion  of  the  nuts  is  enlarged,  permitting  a  bar  when  screwed 
in  one  end  to  travel  within  one  sixteenth  of  an  inch  oi  the  other 
end.      Fig.   107  --hows  this  clearly.     B  C  is  the  enlarged  cen- 


At  THOU  S  APPLIANCES. 


81 


tral  portion,  C  1)  the  left-hand  threaded  end,  and  A  B  the 
right-hand  threaded  end.  If  a  right-hand  threaded  bar  be 
turned  into  the  right-hand  end  of  the  nut  A  the  bar  can  be 
turned  through  to  the  point  C.  Likewise,  if  a  left-hand 
threaded  bar  be  turned  into  the  left-hand  end  C  D  it  may  be 
turned  through  to  the  point  B. 

104.  However,  when  making  np  a  jack-screw  it  is  always 
advisable  to  cut  the  threaded  bars  so  that  they  will  meet  as 
nearly  as  possible  in  the  center  of  the  nut.  Holes  are  drilled 
through  the  squared  portion  of  the  nut  No.  25,  through  which 
a  small  sharp  instrument  may  be  placed  to  hold  the  nut  while 
the  lock  nut  is  being  turned  tightly  against  the  right-hand  end 
with  a  wrench. 

Fief.  108. 


LENGTH  ONE-HALF  INCH. 


A        B 


LENGTH  ONE-HALF  INCH. 


©=tttttt 


Fig.  109. 

HI 


LENGTH   ONE-HALF   INCH. 

105.  There  are  three  ball  bars  which  are  numbered  21, 
3$  and  57.  Nos.  21  and  33,  shown  in  Fig.  108,  are  left-hand 
threaded  and  operate  in  the  left-hand  end  of  the  nuts  Nos.  25 
and  26.  The  only  difference  in  these  parts  is  that  the  neck  of 
the  No.  21  is  bent  while  the  neck  of  the  No.  33  is  straight.     No. 


Sj 


ORTHODONTIA. 


$j,  shown  in  Fig.  109.  is  right-hand  threaded  and  operates  in 
the  right-hand  threaded  end  of  the  nuts  Nos.  25  and  26.  This 
part  is  used  only  when  it  is  desired  to  place  a  ball  bar  in  both 
ends  of  a  Xo.  25  or  No.  26. 

Fig.  1 10. 


106.  The  ball  cap  No.  24,  shown  in  Fig.  no,  is  threaded 
to  screw  onto  the  stud  of  a  studded  band  and  connects  the 
rounded  head  of  the  ball  bars  with  the  stud  of  the  band.  Fig. 
in  gives  two  sectional  views  of  the  part.  The  threaded  por- 
tion D  screws  onto  the  stud  of  a  studded  band  and  is  of  suffi- 
cient diameter  to  permit  the  entire  ball  bar  to  pass  through  this 

Fie.  ill. 


Fie.  112. 


threaded  portion.  'I  here  is  a  constriction  in  the  ball  cap  at  E. 
This  part  is  of  sufficient  diameter  to  permit  the  threaded  por- 
tion of  the  ball  bar  C  and  neck  B  (Fig.  108)  to  pass  through, 
but  the  ball  A,  which  is  of  greater  diameter  than  the  thread 
C,  is  prevented  from  passing  entirely  through  the  ball  cap  by 
the  constriction  at  !•'..     The  neck  I'.,  Fig.  [08,  tapers  toward  the 


author's  appliances. 


83 


ball.  This  allows  the  ball  bar  considerable  lateral  movement, 
and  still  holds  it  firmly  to  the  stnd  of  the  band.  See  Fig.  112. 
While  the  ball  cap  is  screwed  loosely  to  the  stud  the  ball  is  free 
to  move,  but  when  the  ball  cap  is  tightened  the  ball  is  locked 
against  the  stud  of  the  band,  making  an  immovable  joint. 

107.  The  T  bar  No.  40,  Fig.  113,  is  left-hand  threaded  and 
operates  in  the  left-hand  end  of  the  nuts  Nos.  25  and  26.  It 
takes  the  place  of  the  ball  bar  when  it  is  desirable  to  have  a  T 
head  at  each  end  of  the  jack-screw,  as  in  expansion  appliances. 

Fig.  113. 


■— «       LENGTH   THREE-EIGHTHS  INCH. 

Fig.  114. 

mmm 

LENGTH  THREE-FOL'RTHS  INCH. 

108.  The  T  bar  Xo.  20,  Fig.  114,  is  right-hand  threaded, 
operating  in  the  right-hand  end  of  the  nuts  Nos.  25  and  26. 
The  threaded  portion  is  longer  than  that  of  the  No.  40.  It  is 
made  long  enough  for  the  longest  reach  and  in  nearly  every 
case  must  be  cut  shorter ;  in  fact,  the  No.  20  is  the  only  part 
that  needs  to  be  cut  in  making  any  length  jack-screws.  The  T 
head  of  both  the  Nos.  20  and  40  fits  into  the  round  T  socket  of 
the  Nos.  28,  31  and  32. 

109.  The  lock  nut  No.  23,  shown  in  Fig.  115,  is  simply  a 
square  nut  originally  designed  to  be  placed  on  the  No.  20  and 
operate  against  the  end  of  the  nuts  No.  25  and  No.  26,  to  lock 
the  appliance,  but  it  can  be  used  on  all  right-hand  threaded 
bars  and  the  Ions:  screw  of  the  screwr  bands. 


84 


ORTHODONTIA. 


i io.  The  round  T  socket  clutch  bar  No.  28,  Fig-.  116,  sin- 
gle auxiliary  T  socket  Xo.  31,  Fig.  119,  and  double  auxiliary 
T socket  X0.32.  Fig.  121,  serve  to  hold  the  T  heads  of  the  T  bars 
to    the   anchor   portions   of   the    appliances.     In    the    round    1l 

Fig.  115. 


socket  clutch  bar,  Fig.  116,  the  round  T  socket  is  attached  to  a 
threaded  bar.  Between  the  threaded  portion  of  the  bar  and  the 
head  is  a  cylindrical  enlargement  of  the  same  diameter  as  the 
cylindrical  end  of  the  clutch  nut,  see  Fig.    117,  which   serves 

Fie'.  116. 


Fig.  117. 


118. 


to  hold  this  end  of  the  No.  28  in  the  clutch  tube  by  entering 
one  of  tin-  recessed  openings.  When  the  clutch  nut,  shown  on 
the  threaded  portion,  Is  turned  into  the  other  end  of  the  clutch 
tube,  the  No.  28  is  held  firmly  in  the  tube.  Fig.  1  [8  shows  the 
round  T  socket  clutch  bar  in  position  in  the  clutch  tube  of  a 
molar  hand. 


AUTHOR  S   AIT'UAXC'KS. 


85 


in.     The  single  auxiliary  T  socket  No.  31,  shown  in  Fig. 
119,  has  exactly  the  same  form  of  head  for  the  reception  of  the 
T  bar  as  the  No.  28,  but  in  place  of  a  threaded  bar  for  attach- 
ing. 119. 


ment  to  the  clutch   tube   of  the   molar  band  it   has   a   round 
threaded  nut  which  affords  attachment  to  the  long  screw  of 

Fier.  120. 


the  molar  band.     It  will  operate  also  on  the  T  bars  Nos.   19 
and  20,  the  arch  bar  No.  35,  stud  bar  No.  53  and  ball  bar  No.  57. 

Fig.  121. 


This  part  is  by  far  the  most  important  of  the  three  on  ac- 
count of  its  greater  range   of  adaptability.     In   Fig.    120  the 

Fier.  122. 


No.  31  is  shown  in  position  on  the  screw  of  a  molar  band. 

112.     The  double  auxiliary  T  socket  No.  32,   Fig.   121,  is 
the  same  as  the  No.  31,  except  that  it  has  two  T  socket  heads 


86  ORTHODONTIA. 

for  die  reception  of  the  T  head  of  the  No.  20s,  and  is  used  only 
when  three  jack-screws  are  to  be  used  in  combination,  as 
shown  in  Fig.  122. 

113.  The  manner  of  inserting  the  T  head  of  a  T  bar  in 
the  round  T  socket  of  either  of  these  three  parts  is  clearly 
shown  in  Figs.  123  and  124.  The  bifurcated  head  of  the  round  T 
socket  is  slotted  at  one  end  to  permit  the  neck  of  the  T  bar 
to  pass  into  the  central  transverse  opening.  Fig.  123  shows 
the  single  auxiliary  T  socket  No.  31  in  position  on  one  of  the 
threaded  bars.  To  connect  the  T  head  to  the  round  T  socket, 
place  the  T  bar  parallel  to  the  bar  which  passes  through  the 
single  auxiliary  T  socket  No.  31.  The  T  bar  can  then  be 
placed  in  the  socket,  as  shown  in  Fig.  123.  The  neck  of  the  T 
bar  passes  through  the  slot  at  one  end  of  the  rounded  head 
while  the  squared  head  of  the  T  bar  passes  into  the  hole  in 
the  center  of  the  opposite  end  of  the  head.  As  soon  as  the 
ends  of  the  squared  portion  of  the  T  head  are  flush  with  the 
ends  of  the  round  T  socket  the  T  bar  may  be  turned  at  any  an- 
gle to  the  bar  on  which  the  single  auxiliary  T  socket  is  screwed, 
as  shown  in  Fig.  124.  This  forms  a  swivel  base  of  anchorage 
and  permits  the  jack-screw,  of  which  the  T  bar  forms  a  part, 
to  either  push  or  pull  without  dislodging  the  T  head.  When 
the  jack-screw  is  to  be  removed  it  must  lie  placed  in  the  posi- 
tion shown  in  Fig.  123,  when  it  can  be  easily  slipped  out  of  the 

T  socket. 

114.  The  long  T  bar,  No.  i<j.  is  the  same  as  the  No.  20. 
except  that  the  threaded  portion  is  very  much  longer,  being  of 
the  same  length  as  the  stud  liar.  No.  53.  Fig.  125  shows  the 
Xo.    19. 

115.  The  stud  bar,  Xo.  53,  shown  in  Fig.  126,  and  the  stud 
bar  nnt,  Xo.  54,  shown  in  Fig.  127.  arc  very  useful  parts  of 
these  appliances.     The  nut,  Xo.  54,  in  section,  and  the  stud  liar 


AUTHOR  S  APPLIANCES. 


87 


Fig.  123. 


Fig.  124. 


Al'THok  S   APPLIANCES. 


89 


more  enlarged,  are  shown  in  Fig.  128.  The  nut  is  threaded  at 
E  to  fit  on  the  stud  of  any  of  the  studded  bands.  The  cylin- 
drical portion,  F,  fits  into  the  opening,  D,  of  the  head  of  the 

Fig.  125. 


stud  bar.     The  head  of  the  stud  bar.  A,  is  held  between  the 
flange  of  the  nut,  G,  and  the  base  of  the  stud  of  the  band  when 


Fig.  12C). 


(QHra 


the  nut  is  screwed  onto  the  stud.    H  is  the  squared  portion  of 
the  nut  for  the  operation  of  the  wrench. 

This  forms  a  firm  joint  between  the  stud  bar  and  the  band, 
and  is  easily  placed  in  position  or  removed.     Fig.  129  is  an  en- 
Fig.  127. 


larged  illustration  of  this  connection.  The  neck,  B,  of  the  stud 
bar  may  be  bent  so  that  the  head.  A,  is  at  any  angle  to  the 
threaded  portion,  C.  This  permits  the  stud  bar  to  be  fitted  to 
the  stud  of  a  band  whatever  the  direction  of  the  stud  may  be, 
compared  to  the  direction  of  the  threaded  portion  of  the  stud 
bar.  C. 


90 


ORTHODONTIA. 


116.  The  arch  bar  No.  35,  Fig.  130,  is  a  bar  five  and  one- 
half  inches  long,  threaded  its  entire  length.  The  bar  and 
threads  are  of  the  same  diameter  and  pitch  as  all  the  right- 
hand  threaded  parts,  except  the  studs  of  bands,  and  all  the  nuts 
will  operate  on  this  bar  except  Xos.  24,  54  and  38.  which  are 

Fie:.  128. 


used  on  the  studs  only.  The  arch  bar  is  of  sufficient  length  to 
encircle  the  largest  arch  and  is  generally  long  enough  to  make 
two  bars  when  used  on  the  inside  of  the  arch.  There  is  no 
more  important  part  in  these  appliances  than  the  arch  bar,  as  it 
has  an  extremely  wide  range  of  adaptability. 


Fig.  129. 


BlMt»fflBS» 


117.  The  bar-end  cap,  No.  34,  shown  in  Fig.  131,  serves  to 
protect  the  soft  t  i  -  - 1  k---  of  the  mouth  from  irritation  which 
might    be    caused    by    the    projecting    ends    of    threaded    bars. 


author's  appliances.  <;' 

When  the  bar-end  cap  is  used  the  bars  may  project  much 
farther  back  of  the  clutch  tubes  than  when  some  means  of 
protection  is  not  used.  Fig.  132  shows  a  sectional  drawing 
of  the  bar-end  cap  and  also  shows  the  cap  in  position  on  the 

Fiq\  1^0. 


ends  of  threaded  bars.     This  part  is  threaded  at  A  to  screw 
onto  the  end  of  the  bar.     It  cannot,  however,  be  operated  as  a 
nut.    The  constriction  at  B  prevents  the  bar  being  turned  en- 
Fig.  131. 


tirely  through  the  cap  and  also  permits  the  cap  to  be  turned 
tightly  onto  the  bar  so  it  cannot  be  loosened  without  the  em- 
ployment of  a  wrench. 


02 


ORTHODONTIA. 


118.  The  perforated  stud.  No.  36,  Fig.  133,  screws  into 
the  ball  cap,  No.  24.  and  has  a  hole  in  its  flattened  portion 
through  which  a  double  strand  of  band  wire,  No.  30,  may  be 

Fig.  132. 


passed,  serving  as  a  means  for  connecting  the  jack-screw  to  the 
buttons  of  a  band,  as  is  sometimes  employed  in  tooth  rotation. 

Fig.  133- 


119.  The  retaining  clamp.  No.  $/,  shown  double  size  in 
Fig.  134.  is  perforated  in  the  center  to  pass  over  the  stud  of  a 
band.  The  projecting  ends  over-la])  the  adjoining  tooth  on  each 
side  and  serve  to  hold  the  tooth  in  position,  after  it  has  been 
moved  out  into  line,  when  the  retaining  clam])  nut,  No.  38,  Fig. 
[35,  is  screwed  onto  the  stud.  The  combination  of  the  parts, 
No.  $J  and  No.  38,  used  in  connection  with  a  studded  band,  also 
make  a  convenienl  and  effective  regulating  appliance  in  minor 
operat  ions. 


AUTHOR  S  APPLIANCES.  <j3 

120.  The  retaining  and  connecting  band,  No.  39,  shown 
exact  size  in  Fig.  136,  is  a  blank  band  of  the  same  thickness 
and  temper  as  the  retaining  clamp,  Xo.  37.    It  is  to  be  prepared 

Fig.  134. 


for  connecting  a  number  of  teeth,  when  they  are  all  to  be 
moved  in  the  same  direction,  by  punching  holes  in  the  band 
for  the  reception  of  the  studs  of  the  bands.     The  connecting 

Fig-  135- 


band  is  held  to  the  studs  by  means  of  the  retaining  clamp  nuts, 
Xo.  38.  It  is  also  to  be  made  as  a  retainer  when  a  number  of 
teeth  are  to  be  held  in  line,  making  it  necessary  to  place  bands 

Fig.  136. 

on  two  or  more  teeth.  This  is  further  explained  under  the 
head  of  Retaining  Devices. 

Fig-  137- 


121.     Fig.  137  shows  the  bar  hook,  Xo.  55.     This  part  is 
used  principally  with  the  protrusion  appliance  to  connect  the 


"4 


ORTHODONTIA. 


springs,  No.  56,  with  the  clutch  tubes  of  the  molar  bands,  and 
also  to  hold  the  arch  bar,  No.  35,  in  the  clutch  tubes.  It  also 
affords  convenient  attachment  for  rubber  ligatures  when  placed 
on  any  of  the  threaded  bars. 

122.  The  principal  office  of  the  springs,  No.  56,  shown  in 
Fig.  138,  is  to  retain  during  the  day  the  tooth  movement  gained 
at  night  when  the  head  cap  and  protrusion  bow  are  used. 

Fig.  138. 


123.  Fig.  139  shows  the  detachable  stud,  No.  59.  This 
part  was  devised  to  afford  attachment  for  the  ball  cap  of  the 
jack-screw  at  any  position  on  a  band.     It  is  composed  of  two 


Fig.  139. 


parts,  A  and  B.  The  part  B  is  threaded  both  inside  and  out. 
The  outside  thread  fits  the  ball  cap,  No.  24,  and  the  inside 
thread  screws  onto  the  threaded  part  A.  When  a  hole  has 
been  punched  in  a  band  with  a  plate  punch  and  the  threaded 
portion  of  the  pari  A  passed  through  the  hole  (see  Fig.  140)  the 
threaded  part  B  can  then  be  screwed  onto  the  part  A,  as  shown 
in  Fig,  141,  clamping  the  band  between  the  two  parts.  The 
parts  \  and  B  arc  both  squared  for  the  operation  of  the  wrench 
and  can  be  turned  tightly  together. 


AUTHOR  S  APPLIANCES. 


95 


124.  The  protrusion  bow  and  chuck,  No.  58,  shown  in 
Fig.  142,  afford  means  for  transferring  the  retractive  pressure 
exerted  by  the  head  cap  rubbers  to  the  arch  bar.     The  protru- 

Fig.  140. 


rig.  141. 


sion  bow  has  at  its  center  the  pivoted  standard,  A,  which  tel- 
escopes over  the  split  chuck  B.  The  chuck  B  is  transversely 
bored  and  threaded  and  when  it  is  sprung  onto  the  arch  bar  it 

Fig.  142. 


grips  the  bar  firmly.  A  sectional  drawing  of  these  parts  in 
position  on  an  arch  bar  is  given  in  Fig.  143.  The  retractive 
pressure  exerted  through  the  standard  A,  on  the  chuck  B. 
causes  the  chuck  to  more  firmly  grip  the  arch  bar.  as  it  is  con- 
ically  seated  in  the  standard  A. 


96 


ORTHODONTIA. 


125.  The  advantage  of  this  combination  will  be  appreci- 
ated when  it  is  considered  that  to  accidentally  disconnect  the 
protrusion  bow  from  the  arch  bar  it  will  be  necessary  to 
throw  the  standard  A  entirely  off  the  chuck  B,  a  distance  of 
three-eighths  of  an  inch.     Also,  if  this  should  occur  the  stan- 

Fig.  143. 


dard  A  cannot  cause  damage  to  the  soft  tissues  of  the  mouth, 
as  is  often  the  case  with  the  old  forms  of  protrusion  bows,  where 
the  standard  is  attached  rigidly  to  the  bow,  for,  the  standard 
being  free  to  tip  in  either  direction,  would  immediately  tip  to 
one  side,  permitting  only  the  smooth  rounded  portion  of  the 
standard  or  protrusion  bow  to  come  in  contact  with  the  tissues 
of  the  mouth. 

The  fad  that  the  protrusion  bow  is  free  to  rock  on  the 
standard  A,  prevents,  to  the  greatest  extent,  shocks  being 
transmitted  from  the  protrusion  bow  to  the  teeth  when  an  end 
of  the  bow  strikes  the  pillow.  Fig.  144  illustrates  this.  When 
the  bow  is  at  the  position  indicated  by  D  G,  and  the  patient 
strike-  the  end  D  forcibly  against  the  pillow,  the  end  1)  is 
driven  into  contact  with  the  cheek  as  shown  at  E.  The  oppo- 
site end  of  the  bow  rises  a  corresponding  distance,  that  is,  from 
( 1  to   I',  which   Stretches  the  rubbers  on   that   side  and   loosens 


AUTHOR  S   APPLIANCES. 


97 


V 


O 


AUTHOR  S  APPLIANCES.  99 

the  rubbers  which  are  attached  to  the  end  D.  Thus  the  shock- 
is  really  transmitted  to  the  rubbers  on  the  opposite  side  and 
the  position  of  the  standard  is  not  changed. 

As  soon  as  the  pressure  is  relieved  the  rubbers  immediately 
draw  the  protrusion  bow  back  to  its  original  position.  Also,  if 
the  patient  should  lie  for  some  time  with  the  end  D  of  the  pro- 
trusion bow  between  the  cheek  and  the  pillow,  thus  de- 
pressing the  end  D  to  E,  direct  backward  pressure  would  be 
exerted  on  the  chuck  by  the  protrusion  bow  the  same  as  when 
the  bow  is  at  its  normal  position,  D  G. 

Fig.  145- 


126.  The  head  cap,  No.  60,  shown  in  Fig.  145,  is  made  of 
kangaroo  leather  and  silk  cord.  It  is  light,  cool,  and  adjust- 
able in  all  directions.  It  has  metal  buttons  placed  in  the  prop- 
er positions  for  the  attachment  of  the  rubber  bands  which 
connect  it  with  the  protrusion  bow. 

Fig.  146. 


127.  The  wrench.  No.  29,  Fig.  146,  is  of  a  different  form 
from  those  ordinarily  used  in  operating  regulating  appliances. 
This  form  of  wrench  is  necessary,  however,  with  these  appli- 


100 


ORTHODONTIA. 


ances  on  account  of  the  peculiar  construction  of  the  nuts.  The 
end  which  fits  the  nut  is  at  right  angles  to  the  handle.  This 
makes  the  process  of  placing  ball  caps,  retaining  clamp  nuts, 
etc..  on  the  lingual  surface  of  the  teeth  a  simple  matter.  The 
wrench  is  placed  on  the  squared  portion  of  the  nuts,  as  shown 

Fi.s:-  147- 


Fig.  148. 


in  Fig.  147,  and  rests  against  the  cylindrical  portion,  making  it 
possible  to  carry  the  nut  into  position  and  start  it  on  the  stud, 
as  shown  in  Fig.  148. 

128.     As  it  i1-   difficult  to  turn  the  nnts  on   threaded  bars 
when  th<-  bars  an-  On    the  lingual  surfaces  of  the  lower  molars. 


AUTHOR  S   APPLIANCES. 


KM 


and  bicuspids,  with  the  ordinary  wrench,  a  pair  of  wrenches 
with  an  extra  curve  in  the  neck  are  made,  as  shown  in  Fig.  149, 
for  this  purpose  only.  Fig.  150  shows  one  of  these  wrenches 
in  position  to  operate  nuts  which  are  on  the  lingual  surface  of 

Fig.  149. 


f 


R 


Fig.  150. 


the  lower  teeth  on  the  right  side  of  the  arch.  As  it  is  neces- 
sary to  have  a  wrench  for  each  side,  they  are  made  right  and 
left  and  the  pair  numbered  70. 


io; 


ORTHODONTIA. 


CHAPTER  VII. 


THE  JACK-SCREW 


129.  The  jack-screw  proper  consists  of  five  parts,  and  is 
so  constructed  that  it  will  operate  equally  well  in  either  direc- 
tion, while  each  end  has  secure  attachment  which  prevents  it 
from  being  displaced  while  in  use.  The  general  form  of  a  jack- 
screw  organization  is  shown  in  Fig.  151.  The  elongated  nut, 
Xo.  25,  is  right-hand  threaded  at  one  end  and  left-hand 
threaded  at  the  other.     The  squared  central  portion  of  this  nut 


1-  marked  at  one  end  with  an  L,  which  indicates  the  left-hand 
threaded  end  of  the  nut.  The  L  should  be  carefully  noted 
when  organizing  the  jack-screw.  A  short  T  bar,  No.  20,  is 
screwed  into  the  right-hand  end  and  a  ball  bar,  No.  21,  into  the 
left-hand  end. 

130.  A  ball  cap,  No.  24,  incloses  the  ball  of  the  ball  bar, 
No.  21,  and  when  this  cap  is  screwed  to  the  stud  of  a  studded 
band  this  end  of  the  jack  screw  is  clamped  firmly  to  the  band. 


THE  JACK-SCREW. 


103 


The  T  bar,  which  is  the  anchor  end  of  the  jack-screw,  connects 
with  the  round  T  socket  clutch  bar,  No.  28,  the  single  auxiliary 
T  socket,  No.  31,  or  the  double  auxiliary  T  socket,  No.  32. 

131.  A  lock  nut.  No.  27,,  is  always  placed  on  the  No.  20, 
and  must  be  kept  tightened  against  the  right-hand  end  of  the 
long  nut,  No.  25,  to  keep  it  from  revolving,  which  would  result 
in  the  loss  of  a  movement  once  gained.  This  permits  the 
teeth  to  be  moved  a  certain  distance  and  held  rigidly  in  that 
position  until  the  appliance  is  again  tightened  by  the  operator. 

Fig.  152. 


132.  Fig.  152  shows  the  jack-screw  in  section,  the  ball 
cap  of  which  is  attached  to  a  studded  band.  The  T  head  of 
the  T  bar,  No.  20,  connects  with  the  round  T  socket  of  a  No. 
28,  which  has  been  placed  in  the  clutch  tube  of  a  molar  band. 
When  the  long  nut,  No.  25,  is  turned  to  the  right,  as  indicated 


[04 


0RTH0D0N1 IA. 


at  A.  the  fack-screw  expands;  when  turned  to  the  left,  as  indi- 
cated at  B,  it  contracts.  In  Fig.  152  the  hall  bar,  No.  21,  is 
used.  The  straight  neck  ball  bar,  No.  33,  may  be  used  in  place 
of  the  Xo.  21  whenever  desired.      See  A,  Fig.  153. 

133-  When  the  No.  33  is  used  the  jack-screw  may  be  per- 
fectly straight,  as  shown  at  A,  or  the  ball  cap  and  band  may 
be  tipped  a  certain  amount  without  bending  the  neck  of  the 

Fig-  153- 


ball  bar,  as  shown  at  B.  If  a  tooth  stands  in  such  a  position 
that  it  is  necessary  for  the  band  to  be  tipped  still  more,  as 
shown  at  C,  the  No.  21  should  be  employed  or  the  neck  of  the 
N°-  33  bent.  When  the  No.  21  is  used  the  band  can  be  still 
further  tipped,  as  shown  at  I),  without  changing  the  bend  in 
the  neck.  By  bending  the  neck-  the  band  may  be  at  right  an- 
gles to  the  jack-screw,  as  shown  at  E.  It  is  necessary,  there- 
Fore,  simpl)  to  bend  the  neck  of  the  ball  bar  of  a  jack-screw  in 
order  to  reach  a  tooth  in  any  position. 


THE  JACK-SCREW.  105 

As  the  connection  between  the  T  head  of  the  T  bar  and 
the  round  T  socket  head  is  a  swivel  joint,  the  jack-screw  may 
be  connected  to  any  of  the  teeth  from  one  base  of  anchorage 
as  illustrated  at  A,  B  and  C,  Fig.  154.  When  the  jack-screw 
extends  across  the  mouth,  as  at  A,  or  directly  forward,  as  at 
C,  it  is  usually  necessary  to  use  the  short  nut,  No.  26,  in  place 

Fig.  154- 


of  the  long  nut,  No.  25.  The  T  bar,  No.  20,  is  made  long- 
enough  for  the  longest  reach,  and  will  need  to  be  shortened 
in  nearly  every  case. 

134.  When  the  length  of  a  jack-screw  is  to  be  ascer- 
tained, proceed  as  follows:  If,  as  in  Fig.  155,  a  lateral  is  to  be 
moved  out  of  inlock,  first  cement  the  band  to  the  lateral  ami 
place  the  anchor  bands  in  position.  Then  connect  the  ball  bar 
to  the  studded  band  with  the  ball  cap  and  place  the  T  bar  in 


io6 


ORTHODONTIA. 


the  T  socket  head,  letting  the  hall  bar  and  the  T  har  pass  each 
other,  as  shown  in  Fig.  156.  Then  cut  the  No.  20  at  the  point 
A,  Fig.  157,  with  wire  cutters;  next,  entirely  remove  the  burr 

Fig.  155- 


left  by  the  wire  cutters,  from  the  No.  20  with  a  file.  The  ends 
of  the  ball  bar  and  T  har  will  then  be  in  the  position  shown 
in  Fig.  158.      The  hall  bar  and  T  bar  should  then  be  removed 

Fig.  156. 


and  screwed  into  the  long  nut  until  they  meet  in  the  center 
of  tbe  nut.  The  jack-screw  is  then  of  the  proper  length  to  be 
placed  in  position,  a^  shown  in  Fig.  [59. 


THE  JACK-SCREW 


107 


The  foregoing  applies  equally  as  well  when  a  jack-screw 
is  fitted  to  the  mouth  as  when  fitted  to  the  cast. 

Fig.  157. 


Fig.  158. 


135.     In  this  case,  as  the  lateral  is  to  be  moved  away  from 
the  point  of  anchorage,  the  jack-screw  increases  in  length  and 


io8 


ORTHODONTIA. 


the  ball  bar  and  T  bar  move  away  from  each  other  each  time 
the  appliance  is  tightened. 

136.     If  a  tooth  is  to  be  moved  into  the  arch,  so  the  jack- 
screw  contracts  during  the  operation,  sufficient  space  must  be 

Fig.  159. 


left  between  the  ends  of  the  ball  bar  and  the  T  bar  to  allow 
proper  contraction  of  the  jack-screw.  Fig.  160  shows  the  rela- 
tive positions  of  the  ends  of  these  parts  after  the  T  bar  has 

Fief.  160. 


been  cul  to  the  proper  length.  The  distance  between  the  ends 
should  be  a  little  mure  than  the  distance  tlie  tooth  is  to  be 
moved.     The  ball  bar  and  T  bar  can  then  be  removed,  screwed 


THE  JACK-SCREW 


ini) 


into  the  long'  nut,  and  the  jack-screw  connected,  as  shown  in 
Fig.  161. 

At  the  beginning  of  the  operation  the  ends  of  the  ball  bar 
Fig.  161. 


and  T  bar  are  separated  in  the  long  nut,  as  shown  in  Fig.  162. 
As  the  case  progresses  the  ends  approach  each  other  and  if  they 


Fie\  162. 


IJ^_^ 


should  come  in  contact,  as  shown  in  Fig.  163,  before  the  tooth 
is  in  position,  it  will  be  necessary  to  remove  the  jack-screw 

Fig.  163. 


and  cut  the  No.  20  still  shorter.  When  these  ends  are  in  con- 
tact and  the  operator  attempts  to  still  further  contract  the 
jack-screw,  using  undue   force,  as   is   sometimes   done,  some- 


IIO  ORTHODONTIA. 

thing  must  break,  and  it  is  generally  the  T  head  of  the  No. 
20.  In  every  case  that  has  come  under  the  author's  notice 
where  the  T  head  of  the  T  bar  has  been  broken  off  it  has  been 
done  in  this  manner.  A  little  thought  on  the  part  of  the  oper- 
ator would  have  prevented  the  accident  and  subsequent  delay 
to  the  case. 

137.  The  jack-screw  admits  of  numerous  changes  in  form 
which  make  it  suitable  for  many  purposes.  The  ordinary 
jack-screw,  before  described,  is  shown  in  Fig.  164.  By  substi- 
tuting for  the  long  nut.  No.  25,  a  short  nut,  No.  26,  as  shown 
in  Fig.  165,  a  much  shorter  jack-screw  is  obtained.  Then  by 
removing  the  Nos.  33  and  24,  and  using  in  their  stead  a  left- 
hand  threaded  T  bar.  No.  40,  a  jack-screw  with  a  T  head  at 
each  end  is  formed,  as  shown  in  Fig.  166.  This  is  the  one 
used  in  arch  expansion.  Again,  by  substituting  for  the  No.  20, 
Fig.  164,  a  right-hand  threaded  ball  bar.  No.  57,  and  a  No.  24, 
a  jack-screw  which  will  connect  to  a  studded  band  at  each  end 
i-  formed.  This  is  shown  in  Fig.  167.  When  the  long  nut  is 
turned  to  the  right,  as  indicated  at  A,  Fig.  168,  both  ball  bars 
are  forced  out  of  the  nut,  as  shown  at  BB,  expanding  the  jack- 
screw.  When  the  long  nut  is  turned  in  the  opposite  direction 
the  jack-screw  contracts. 


THE  JACK-SCREW. 


Ill 


23       20 


d^iiiu<ituuiuumMUiu#vmu\\iuuuu\= 


Fig-.  165. 
24     33  26  23     20 


iHllffliMfflfflffl 


u 


40 

r 


Fie.  166. 


26  23 


20 


■lifillfi^ 


Fig.  168. 


JACK-SCREW  ANCHORAGE. 


113 


CHAPTER  VII T. 


JACK-SCREW  ANCHORAGE. 


138.  The  round  T  socket  clutch  bar,  No.  28,  and  single 
auxiliary  T  socket,  No.  31,  afford  means  for  anchoring  the 
jack-screw  to  one  or  more  teeth  in  a  variety  of  ways.  When 
one  molar  tooth  is  to  be  used  for  anchorage  the  No.  28  may  be 

Fig.  i6q. 


placed  in  the  clutch  tube  of  the  molar  band,  as  shown  in  Fig. 
169,  or  the  No.  31  may  be  placed  on  the  screw  of  the  molar 


H4 


ORTHODONTIA. 


band,  as  shown  in  Fig.  170.      This  leaves  the  clutch  tnbe  free 
so  it  can  be  used  in  combination  with  other  appliances. 

139.  If  the  jack-screw  is  to  be  anchored  to  a  molar  and  a 
bicuspid  these  teeth  may  be  banded  with  a  double  socket  and 
a  single  socket  band  as  shown  in  Fig.  171  and  the  No.  28 
clamped  to  the  clutch  tubes  of  both  bands  by  the  addition  of 
a  nut  No.  22  and  a  No.  23  placed  as  shown  in  the  drawing. 
This  serves  to  lock  both  teeth  firmly  together. 

Fig.  170. 


140.  The  same  result  may  be  obtained  by  placing  a  No. 
31  'Mi  tin-  long  screw  of  a  molar  band,  as  shown  in  Fig.  172. 
Here  a  No.  22  and  a  No.  23  are  placed  on  the  screw  to  lock  the 
molar  and  bicuspid  bands  firmly  together.  This  affords  se- 
cure attachment  whether  the  jack-screw  is  being  expanded  or 

contracted  and   IS   the   form   most    commonly   used. 

If.  however,  the  jack-screw  is  to  be  expanded  the  nuts 

\os.  22  and  j^  may  be  dispensed  with,  as  shown  at  (',  Fig.  173. 


JACK-SCREW  ANCHORAGE. 

Fig.  171. 


115 


Fig-.  172. 


11.. 


ORTHODONTIA. 


When   both   bicuspids   and   a   molar  are   included   in   the 
anchorage  the  construction  of  the  appliance  is  shown  in  Fig. 

Fig.  173. 


Fig.  174. 


174.     The   No.  .-,1   may  be  placed  on   the  screw  of  the  molar 
hand  at   any  position.     In  the  drawing  ii   is  shown   between 


JACK-SCREW  ANCHORAGE. 


II 


the  first  and  second  bicuspids.  A  detail  of  the  connection  be- 
tween the  screw  of  the  molar  band  and  the  clutch  tube  of  the 
first  bicuspid  band  is  given  in  Fig.  175.    The  molar  band  screw, 

Fig-  i?5- 

c 


D,  is  placed  in  the  clutch  tube  of  the  band,  B,  and  the  clutch 
nut.  E,  turned  into  the  recessed  opening-  of  the  clutch  tube.  The 
Xo.  31  is  placed  on  the  screw  of  the  molar  band  in  contact 
with  the  distal  end  of  the  clutch  tube,  C.  When  the  nut,  E, 
is  turned  tightly  into  the  tube  the  clutch  tube,  C,  is  locked  firm- 
ly between  the  Xo.  31  and  the  nut,  E. 

Fig.  176. 


141.  In  Fig.  176,  four  teeth  are  banded  and  connected.  In 
this  case,  as  the  length  of  the  screw  of  the  molar  band  is  not 
sufficient  to  reach  to  the  cuspid,  a  piece  of  arch  bar.  Xo.  35, 
upon  which  the  necessary  nuts  have  been  placed,  serves  to  con- 
nect  the   clutch   tubes  of  the   bands.     It   is   seldom   necessary 


n8 


ORTHODONTIA. 


to  band  four  teeth  ;  nevertheless,  to  illustrate  the  adaptability 
of  these  appliances  in  extensive  anchorage,  another  drawing  is 
given  in  Fig.  177, 

Here  the  jack-screw  is  in  position  as  it  would  be  to  draw 
an  outstanding  cuspid  into  the  arch,  the  arrow  at  B  indicating 
the  direction  of  movement  when  the  long  nut  is  turned  to  the 
left,  as  indicated  at  A.  If  the  cuspid  stood  inside  the  arch  the 
jack-screw  must  necessarily  be  operated  in  the  opposite  direc- 

Fig-  177- 


tion,  as  shown  at  B,  Fig.   178.     To  accomplish   this  the  long 
nut,  No.  25,  must  be  turned  to  the  right,  as  indicated  at  A. 

142.  When  the  jack-screw  is  expanded  the  pressure  is  ex- 
erted  against  the  lingual  surfaces  of  the  teeth  and  only  three 
bands  would  be  necessary,  a>  shown  in  the  drawing.  The 
arch  bar  in  the  intervening  spaces  would  rest  against  the  teeth. 
This  is  a  practical  form  of  appliance  while  the  one  shown  in 
Fig.  177  is  not,  for  h  is  never  necessarj  to  hand  all  the  teeth. 


JACK-SCREW  ANCHORAGE 
Fig.  1/8. 


119 


Fig.  179- 


120  ORTHODONTIA. 

143.  When  the  jack-screw  is  contracting,  an  appliance 
made  np  as  shown  in  Fig.  178  might  not  afford  sufficient  an- 
chorage, for  then  the  force  would  be  exerted  on  only  the  three 
teeth  which  are  banded.  If  the  form  of  appliance  is  changed 
and  the  No.  31  placed  on  the  screw  of  the  molar  band,  the  arch 
bar  placed  outside  the  arch,  as  shown  in  Fig.  179,  and  the  end  of 
the  screw  of  the  molar  band  and  the  arch  bar  connected  by  a 
double  strand  of  band  wire,  as  shown  at  D,  the  same  amount 
of  anchorage  is  obtained  as  in  Fig.  177. 


THE  DOUBLE  JACK-SCREW 


121 


CHAPTER  IX. 


THE    DOUBLE    TACK-SCREW. 


144.  Two  jack-screws  may  be  connected  and  attached  to 
one  base  of  anchorage,  as  shown  in  Fig.  180,  by  placing  an  ex- 
tra No.  31  on  the  Xo.  20.  which  is  seated  in  tbe  T  head  of  tbe 

Fig.  180. 


No.  31  on  the  screw  of  tbe  band.  Tbis  affords  means  for  con- 
necting a  second  jack-screw  to  the  base  of  the  first.  When  the 
tooth  on  which  the  No.  5  band  is  placed  is  being  drawn  in.  and 
the  one  encircled  by  the  Xo.  3  band  is  being  forced  out,  these 


12  2 


ORTHODONTIA. 


opposing  forces  are  equalized  through  the  medium  of  the  No. 
31  on  the  Xo.  20.  This  relieves  the  anchor  tooth  of  all  strain 
when  the  contending  forces  are  equal. 

145.  A  novel  method  of  connecting  two  jack-screws,  by 
omitting  one  Xo.  20  and  one  No.  31  is  given  in  Fig.  181.  Here 
a  No.  31  is  placed  on  the  long  screw  of  the  molar  band  for  the 
connection  of  one  jack-screw,  while  the  long  nut  of  the  other 

Figf.  181. 


jack-screw  is  screwed  directly  onto  the  end  of  the  molar  band 

screw.  The  direct  inn  df  this  jack-screw  may  be  changed  by 
bending  the  molar  band  screw  between  the  Xo.  31  and  the  Xo. 
23,  <>r  between  the  Xo.  31  and  the  screw  band  nut.  This  does 
not  afford  a  movable  connection  between  tbis  jack-screw  and 
the  molar  band,  but  is.  nevertheless,  useful  in  many  cases. 


THE  TRIPLE  JACK-SCREW 


123 


CHAPTER  X. 


THE    TRIPLE    TACK-SCREW. 


146.  Fig.  182  shows  three  jack-screws  connected  and 
operating  from  one  base  of  anchorage.  A  double  auxiliary  T 
socket  Xo.  32  is  placed  on  the  No.  20  of  the  central  jack-screw, 
as  shown  in  the  drawing.  This  affords  attachment  for  two 
more  jack-screws.     "When  the  central  jack-screw  is  contracted 

Fie.  182. 


to  draw  an  out-standing  tooth  into  line,  the  jack-screws  which 
are  attached  to  the  bands  Xo.  3  and  Xo.  $l/2  assist  as  anchor- 
age when  they  are  stationary.  This  is  very  often  necessary 
when  a  refractory  cuspid  is  to  be  drawn  into  the  arch  and  sufti- 


124  ORTHODONTIA. 

cient  anchorage  cannot  be  gained  from  the  opposite  side  of  the 
month,  as  is  sometimes  the  case  when  some  of  the  teeth  on  that 
side  have  been  extracted. 

147.  Also,  by  expanding  the  jack-screws  which  connect 
with  the  bands  Xo.  3  and  Xo.  ^l/2,  these  teeth  may  be  moved 
out  into  line  at  the  same  time  the  out-standing  cuspid  is  moved 
into  the  arch,  the  forces  being  ecjualized  at  the  Xo.  32.  When 
the  teeth  are  very  close  together  and  the  bands  over-lap,  as  in 
Fig.  183,  the  jack-screws  may  be  too  close  together  to  be  easily 
turned  with  the  wrench.    If  the  necks  of  the  T  bars,  XTo.  20,  at 

Fig.  183. 


AA,  of  the  two  outside  jack-screws  are  bent  to  some  extent,  the 
bases  of  the  jack-screws  will  be  separated  so  that  the  luck  nuts, 
No.  23.  and  the  long  nuts.  Xo.  2^.  may  be  operated  easily. 

148.  In  a  case  where  the  first  bicuspid  and  lateral  are  in 
line  and  the  cuspid  -lands  outside  the  arch,  the  triple  jack- 
SCrew  affords  means  for  crowding  it  in  between  the  lateral  and 

bicuspid,  using  the  lateral  and  bicuspid  as  anchorage  so  that 
when  the  cuspid  is   forced   in   between   them   these  teeth  are 

d  apart  to  admit    it. 


STUD  i:.\K  APPLIANCES. 


I2i 


CHAPTER   XI. 


STUD  BAR   APPLIANCES. 


149.  Fig.  184  shows  the  stud  bar  appliance  enlarged.  This 
appliance  is  formed  by  using  a  double  socket  clutch  band,  a 
studded  band,  and  two  clutch  nuts  in  combination  with  the  stud 
bar.  Xo  53,  and  stud  bar  nut,  Xo.  54.     A  sectional  drawing  of 

Fig.  184. 


the  parts  assembled  is  shown  in  Fig.  185.  This  appliance 
operates  equally  well  in  either  direction.  The  clutch  nuts.  Xo. 
22,  serve  to  lock  the  bar  firmly  in  the  clutch  tube  of  the  molar 
baud  and  move  it  forward  or  backward  through  the  tube. 


126 


ORTHODONTIA. 


150.  If  the  nut  No.  22  A,  Fig.  185.  is  turned  one  full 
revolution  out  of  the  clutch  tube,  and  the  nut  No.  22  B  is 
turned  the  same  amount  in  the  same  direction,  the  stud  bar  is 


Fig.  185. 


.■..'..■.y,1..',,  a.,1,.,...,.,..1,  ,,,.,,  1  ■■,,■,,  ,■;■:■,,',,,:,:,  ,:,|,'m',',',',  , ,  ,:Ay.i.i,:.',',,hvy,',',Trr7r7^wro:,',:, 

S3 


moved  back  one  one-hundredth  of  an  inch.  That  is.  the 
studded  band  Xo.  5  is  moved  toward  the  molar  band  one  one- 
hundredth  of  an  inch.  If  the  nut  Xo.  22  B  is  turned  out  of 
the  clutch  tube  one  full  revolution  and  nut  Xo.  22  A  turned 

Fie\  186. 


into  the  tube,  the  stud  bar  is  moved  forward  one  one-hundredth 
of  an  inch,  moving  the  tooth  encircled  by  the  band  No.  5  that 
distance  away  from  the  molar. 

151.  The  stud  bar  nut,  No.  54,  fits  accurately  into  the 
rounded  head  of  the  stud  bar,  No.  53.  When  the  stud  bar  nut 
is  screwed  onto  the  stud  of  any  studded  band  the  stud  bar  is 


STUD   BAB  APPLIANCES. 


I27 


held  firmly  to  the  band  in  such  a  manner  as  to  prevent  rotation 
of  the  tooth.     The  stud  bar  may  be  removed  by  turning  both 

Fig.  187. 


nuts.  No.  22,  out  of  the  clutch  tube  of  the  molar  band,  and 
removing"  the  stud  bar  nut.     The  stud  bar  may  then  be  moved 

Fig.  T88. 


r> 


side-wise  out  of  its  connection  with  the  bands.  This  permits 
the  stud  bar  to  be  bent  in  any  desired  shape  and  fitted  to  places 
otherwise  inaccessible. 


128  ORTHODONTIA. 

152.  A  case  where  both  cuspids  have  erupted  outside  the 
arch  is  given  in  Fig.  186.  The  upper  first  bicuspids  occlude 
one  step  forward  and  the  lip  will  not  admit  of  any  more  promi- 
nence. It  was  necessary,  therefore,  to  extract  the  upper  first 
bicuspids  and  move  the  cuspids  back  and  into  the  arch.  Fig. 
187  shows  the  model  of  the  upper  arch  with  appliances  in 
position.  Two  stud  bar  appliances  are  used,  one  on  either 
side,  to  draw  the  cuspids  into  line.  The  stud  bars  are  bent  to 
pass  around  the  second  bicuspids  and  attached  to  the  studs  of 
the  bands  which  are  cemented  to  the  cuspids  by  stud  bar  nuts, 
No.  54.     In  operation  the  nuts  anterior  to  the  clutch  tubes  of 

Fig.  189. 


nut,  No.  38.  The-  ends  of  the  retaining  clamp  are  bent  to  press 
the  molar  bands  are  loosened  and  those  posterior  are  tightened. 
One-half  a  revolution  (1/200  inch)  per  day  is  usually  the 
proper  amount  to  tighten  an  appliance  of  this  form  when  mov- 
ing  a  cuspid.  As  the  stud  bar  muxes  back  it  comes  in  contad 
with  the  lir-i  bicuspid,  which  assists  in  drawing  the  cuspid 
into  the  arch.     Fig.  [88  is  a  detail  of  the  appliance. 

I53-  Fig.  189  shows  the  same  rase  nearly  completed.  The 
stud  bar  has  been  removed  From  one  side  and  a  retaining  clamp. 
No.  37.  attached  to  the  stud  of  the  baud  with  a  retaining  clamp 


STUD  BAR  APPLIANCES.  I2Q 

firmly  on  the  lateral  and  first  bicuspid,  the  spring  action  of 
which  will  move  the  lateral  out  and  the  cuspid  in,  completing 
the  proper  aligning  of  the  teeth. 

Fig.  190. 


The  reason  for  placing  this  retaining  clamp  in  position  to 
finish  the  case  is  that  the  stud  bar  had  retracted  the  cuspid 
until  it  was  in  contact  with  the  second  bicuspid  and  the  stud 

Fig.  191. 


bar  could  not  be  further  operated  to  advantage,  therefore  it 
was  removed  and  the  retaining  clamp  substituted.  On  the  left 
side  it  will  be  seen  that  the  cuspid  is  not  yet  in  contact  with  the 
second  bicuspid  but  since  the  curve  of  the  stud  bar  is  in  contact 


13° 


ORTHODONTIA. 


with  the  second  bicuspid,  this  will  assist  in  drawing  the  cuspid 
into  the  arch  while  it  is  being  retracted.  The  retaining  clamp, 
shown  on  the  right  side,  is  used  also  to  retain  the  cuspid  after 
it  is  in  perfect  line. 

154.  Fig.  [90  shows  the  stud  har  attached  to  the  molar 
hand  on  the  right  first  molar,  passed  around  the  outside  of  the 
arch  and  attached  to  the  stud  of  a  hand  cemented  to  the  right 

Fig.  192. 


central  incisor.  J11  this  case  the  tooth  stood  somewhat  for- 
ward and  was  rotated.  The  action  of  the  stud  har  moved  the 
tooth  back,  rotating  it  as  well.  The  stud  of  the  hand  on  the 
central  was  placed  as  near  the  disto-labio  angle  of  the  tooth  as 
practicable  and  no  stud  har  nut  was  u^vd,  thus  permitting  the 
tooth  to  be  rotated  by  the  pressure  exerted  at  the  disto-labio 
angle.  Fig.  [91  shows  the  completed  case.  Fig.  [92  is  a  drawing 
of  the  appliance  with  the  parts  numbered. 


STUD   BAR  APPLIANCES. 


I  3 ' 


x55-  Fig-  *93  shows  the  same  combination  of  parts  oper- 
ating to  draw  back  and  rotate  a  cuspid.  In  this  case  the  cus- 
pid is  first  drawn  back  until  in  contact  with  the  first  bicuspid 
and  the  pressure  continued  after  cuspid  and  first  bicuspid  are  in 

Fig.  193. 


contact,  to  complete  the  rotation. 

156.     In  the  case  shown  in  Fig.  194  the  bicuspids  were  not 
in  contact  and  there  was  not  sufficient  room  for  the  cuspids. 

Fig.  194. 


It  was  necessary  to  close  these  spaces  and  also  to  move  the 
laterals  forward  to  give  room  for  the  cuspids.  A  Xo.  3  studded 
band  was  cemented  to  each  lateral  with  the  studs  on  the  lingual 


!.32 


ORTHODONTIA. 


surfaces  of  the  teeth.  The  stud  bar  appliance  (detail  of  which 
is  given  in  Fig.  195)  was  placed  on  the  inside  of  the  arch,  con- 
necting the  lateral  and  first  bicuspid  of  each  side.    The  rounded 

Fig.  195- 


-$¥ 


heads  of  the  stud  bars  were  fastened  to  the  studs  of  the  lateral 
bands  with  stud  bar  nuts,  No.  54.    In  operation  the  nuts  at  the 
distal  ends  of  the  clutch  tubes  on  the  bicuspid  bands  were  loos- 
Fig.  196. 


ened  and  those  a1  the  anterior  ends  tightened.  This  moved 
the  laterals  forward,  and  as  the  laterals  came  in  contact  with 
the  centrals  these  teeth  were  moved  before  them.  The  opera- 
tion was  continued  until  tin-  laterals  were  forward  sufficiently 
in  permit  the  rnspids  to  take  their  proper  positions  in  the  arch. 


STUD  BAR  APPLIANCES. 


13; 


The  force  exerted  to  move  the  laterals  forward  also  oper- 
ated to  move  the  first  bicuspids  back  until  in  contact  with  the 
second  bicuspids,  and  sufficient  room  was  gained  for  the  cus- 
pids without  moving  the  laterals  to  any  great  extent. 

J57-  Fig-  196  shows  the  application  of  the  stud  bar  when 
placed  inside  the  arch  to  move  the  central  incisors  forward. 
In  this  case  Xo.  5  studded  bands  are  cemented  to  the  centrals 

Fig.  197. 


with  their  studs  on  the  lingual  surfaces  of  the  teeth.  The 
stud  bars  are  bent,  as  shown  in  the  illustration,  to  permit  the 
studs  of  the  bands  on  the  centrals  to  pass  through  the  heads 
of  the  stud  bars.  The  stud  bar  nuts  are  omitted  since  the 
stud  bars  will  remain  in  position  from  the  pressure  exerted  in 
moving  the  centrals  forward.  Fig.  197  is  a  detail  drawing 
of  the  appliance.     The  arch  bar  appliance  could  also  be  used 


134 


ORTHODONTIA. 


on  this  case,  but  the  appliance  as  shown  in  Fig.  196  has  an 
advantage  over  the  arch  bar  in  cases  where  one  central  is  to 
be  moved  a  greater  distance  than  the  other,  because  with  the 
stud  bars  the  appliances  are  operated  separately  and  either 
tooth  may  be  moved  independently  of  the  other. 

Fig.  198. 


158.  Fig.  108  shows  a  stud  bar  appliance  used  in  connec- 
tion with  a  piece  of  retaining  and  connecting  band,  No.  39, 
to  move  the  four  incisor  teeth  forward.  Studded  bands,  No. 
3,  arc  cemented  to  the  lateral  teeth  with  the  studs  on  the  lin- 

Fig.  [09. 


(71 


gual  surfaces.  A  piece  of  connecting  hand.  No.  39,  is  punched 
to  tit  over  the  studs  of  the  hands  and  cut  narrower  at  its  cen- 
tral portion,  as  shown  in  Fig.  l<j<;.  A  screw  hand,  Xo.  50,  is 
placed  "it  either  molar  with  the  clutch  tubes  on  tin1  lingual 
side  of  the  arch.  A  stud  bar  with  the  head  bent  at  the  proper 
angle  is  placed  011  each  side  of  the  arch  to  connect  the  lateral 
and    molar,  two  clutch    mils,    No.   22,  are  used   on   each   bar  to 


STUD    BAR   APPLIANCES. 


135 


engage  the  clutch  tube  of  the  molar  band,  and  a  stud  bar  nut 
joins  the  head  of  each  stud  bar  firmly  to  the  lateral  hand. 
clamping  the  end  of  the  Xo.  39  between  the  nut  and  hand. 
With  an  appliance  of  this  form  the  four  incisor  teeth  may  he- 
carried    forward    equally    by    turning   the   nuts    engaging   the 

Fig.  200. 


tubes  of  the  molar  bands  the  same  amount ;  or.  if  it  is  desired 
to  move  one  side  of  the  arch  more  than  the  other,  one  of  the 
stud  bars  may  be  left  locked  while  the  other  is  operated.  This 
is  of  advantage  in  some  cases.  Fig.  200  is  a  drawing  of  the 
appliance  with  the  parts  numbered. 

159.  In  the  case  shown  in  Fig.  201  the  teeth  on  the  left 
side  of  the  arch,  to  and  including  the  centrals,  occupied  nearly 
normal  positions,  except  that  the  center  line  between  the  cen- 
trals was  to  the  right  of  the  center  of  the  face.  On  the  right 
side  the  lateral  was  nearly  in  contact  with  the  first  bicuspid, 
affording  no  room  for  the  cuspid  tooth.      It  was  necessary  to 


136 


ORT1H  >Di  >N  J'l  A. 


move  the  left  central  and  lateral  forward  to  give  room  for  the 
cuspid  to  take  its  position  in  the  arch,  and  also  to  swing  the 
whole  anterior  part  of  the  arch  around  so  that  a  line  drawn 

Fig.  201. 


rH^ 

)  .■■ffl  ^ty-  ^ 

^ 

El 

1 

V 

^^    1 

between  the  central  incisors  would  be  in  the  center  of  the  face. 
160.     A  stud  bar  appliance  to  move  the  lateral  and   cen- 

Fisr.  202. 


tral   forward,  widening  the  spare  between   the  lateral  and  first 

bicuspid,  is  shown   in    Fig.  202.     A  studded  band,  No.  3,  is 


STUD   BAR  APPLIANCES.  137 

cemented  to  the  lateral  with  the  stud  projecting  labially.  A 
No.  50  screw  band  is  placed  on  the  molar  with  the  clutch  tube 
buccally.  The  rounded  head  of  a  stud  bar,  No.  53,  is  held 
to  the  stud  of  the  lateral  band  by  a  stud  bar  nut,  No.  54,  and 
the  stud  bar  is  bent  so  that  the  distal  end  passes  through  the 
clutch  tube  of  the  molar  band.  Two  nuts,  No.  22,  are  placed 
on  the  stud  bar  to  engage  the  clutch  tube  of  this  band.  By 
loosening  the  nut  at  the  distal  end  of  the  clutch  tube  and 
tightening  the  one  at  the  anterior  end  the  stud  bar  moves  for- 
ward, accomplishing  the  desired  movement  of  the  lateral  and 
the  central. 

Fig.  203. 


BH^^ife^ 

BT^aPoK 

^~^*WB               H 

HST  *        ^» 

but  ^      1 

r  mi 

a     -  ^^B 

■ "'    jf 

•^   a  ^H 

Bv  j 

r  -#  1 

^*'| 

•*  A 

161.  As  it  is  desirable  to  keep  the  four  incisor  teeth  in 
line  and  swing  them  forward  and  to  the  left,  after  the  case 
has  progressed  to  some  extent  it  is  advisable  to  connect  all 
four  teeth  in  the  manner  shown  in  Fig.  203.  Studded  bands, 
No.  5,  were  cemented  to  the  right  central  and  left  cuspid  with 
the  studs  on  the  lingual  surfaces  of  the  teeth.  A  piece  of  con- 
necting and  retaining  band,  No.  39,  was  cut  and  punched,  as 


138 


ORTHODONTIA. 


shown  in  Fig.  204  E.  and  then  bent  to  conform  to  the  lingual 
surface  of  the  teeth. 

In  preparing  the  connecting  band  for  these  teeth  a  hole 
is  punched  at  A  to  pass  over  the  stud  of  the  central  hand  and 
one  at  B  for  the  stud  of  the  cuspid  hand.     In  cutting  the  hand 


Fig.  204. 


narrower  between  these  teeth,  instead  of  cutting  on  one  side 
only  it  is  cut  away  at  both  I)  and  ('  so  that  the  connecting 
strip  will  pass  obliquely  across  the  width  of  the  No.  30.  By 
so  doing  the  hand  fits  to  tin-  lingual  surface  of  the  teeth  more 
conveniently. 

The  No.  39  is  held  lo  the  studs  of  the  right  central  and 
lefl  cuspid  hands  h\  retaining  clam])  nuts,  No.  38.  The  end 
which  projects  over  the  lingual  surface  of  the  right  lateral 
was  firmlv  wired  t<>  the  buttons  of  the  hand  on  this  tooth  with 


ST  I'D   BAR  APPLIANCES.  [39 

band  wire.  No.  30.  A  drawing  of  this  appliance  is  shown  in 
Fig.  204.  As  all  the  teeth  are  connected  with  the  lateral 
through  the  medium  of  the  connecting  band.  Xo.  39,  the  entire 
anterior  part  of  the  arch  will  be  moved  forward  and  to  the  left. 

Fig.  20  v 


i52.  Fig.  205  is  a  side  view  of  the  cast  showing"  the  stud 
bar  in  position,  as  in  Figs.  202  and  203.  In  this  case,  as  soon 
as  sufficient  space  had  been  gained  for  the  cuspid  this  tooth 
was  drawn  into  the  arch  by  means  of  a  jack-screw,  anchored 

Fie.  206. 


■j^^^LjV*^? 

r 

^r  v              *~m 

^^^fc^  \            M 

jk^V 

w& 

v'lk   ^ 

to  a  bicuspid  ami  molar  on  the  opposite  side  of  the  arch.  As 
soon  as  the  tip  of  the  cuspid  had  passed  under  the  stud  bar  a 
rubber  ligature  was  looped  over  the  neck  of  the  stud  bar  and 
attached  to  the  buttons  of  the  band  on  the  cuspid  to  elongate 


140  ORTHODONTIA. 

that  tooth.     The  case  when  completed  is  shown  in  Fig.  206. 

163.  In  cementing  the  band  to  the  cuspid  the  stud  should 
project  lingually  between  the  lateral  and  first  bicuspid  for  the 
attachment  of  the  ball  cap  of  the  jack-screw,  and  the  band 
should  be  pressed  up  on  the  labial  surface  so  the  buttons  are 
as  near  the  gum  as  is  possible  to  place  them.  This  gives  a 
greater  distance  between  the  buttons  and  stud  bar  for  the  ac- 
tion of  the  rubber.  It  will  be  found,  when  a  band  is  placed 
on  a  cuspid  with  the  stud  projecting  lingually,  that  the  shape 
of  the  tooth  is  such  that  the  band  takes  this  position  naturally. 


ARC  1 1    BAR  APPLIANCES.  I4I 


CHAPTER  XII. 

ARCH    BAR   APPLIANCES. 

164.  The  arch  bar  No.  35  is  one  of  the  most  useful  parts 
of  this  system.  It  is  a  bar  five  and  one-half  inches  long,  and 
is  threaded  its  entire  length.  The  bar  and  thread  are  of  the 
same  diameter  and  pitch  as  all  threaded  parts  and  all  the  nuts 
will  operate  on  this  bar  except  those  used  on  the  studs.  The 
arch  bar  is  of  sufficient  length  to  encircle  the  largest  arch,  and 
will  generally  make  two  bars  of  ordinary  length  when  used 
on  the  inside  of  the  arch,  and  in  some  cases  will  make  three. 
In  fitting  an  arch  bar  to  the  arch  or  to  a  model  it  is,  therefore, 
economical  to  begin  at  one  end  of  the  bar,  placing  this  end  in 
its  position  in  the  clutch  tube  of  the  molar  band  and  bending 
the  bar  to  conform  to  the  shape  of  the  arch.  When  sufficient 
length  has  been  measured  so  it  will  project  properly  through 
the  clutch  tube  on  the  opposite  side,  the  bar  should  be  cut  off 
and  the  surplus  kept  to  be  used  on  another  case.  If  the  arch 
bar  is  bent  from  the  center  back  on  both  sides,  the  projecting 
ends  will  necessarily  have  to  be  cut  off,  thus  causing  waste, 
as  neither  of  these  ends  will  be  of  sufficient  length  for  ordi- 
nary use.  This  arch  bar  forms  an  important  part  of  the  pro- 
trusion appliance. 


U-' 


ORTHODONTIA. 


165.  Fig.  207  shows  the  simple  arch  bar  appliance  used 
to  move  the  central  incisor  teeth  forward.  These  teeth  are 
banded  with  No.  5  studded  bands,  the  hands  having  been  ce- 

Fig.  207. 


Fig-.  208. 


mented  to  the  teeth  and  the  cemenl  allowed  to  harden  before 
the  arch  bar  is  placed  in  position.  No.  50  bands  arc  (damped 
to  the  firsl  molars.     Two  clutch  nuts  arc  used  on  each  side  to 


Ak   APPLIANCES. 


•43 


operate  against  the  clutch  tubes  of  the  molar  bands.  In  all 
cases  like  Fig.  207,  where  the  arch  bar  is  to  move  forward,  the 
nuts  at  the  distal  ends  of  the  clutch  tubes  of  the  molar  bands 
are  loosened  and  those  at  the  anterior  ends  tightened.  This 
moves  the  arch  bar  forward.  It  is  absolutely  necessary  that 
these  nuts  be  firmly  locked  in  the  clutch  tubes  to  prevent  their 
revolving,  which  would  result  in  the  loss  of  movement  once 
gained.  The  two  nuts  are  used  on  each  side  in  order  that  this 
may  be  done.     When  through  carelessness  these  nuts  are  left 

Fig.  200. 


loose  the  operator  must  not  blame  the  patient  or  appliance  for 
lack  of  success  in  the  operation.  The  detail  of  the  appliance, 
with  parts  numbered,  appears  in  Fig.  208. 

166.  Fig.  209  shows  an  arch  bar  appliance  of  the  same 
construction  operating  to  move  two  laterals  forward,  ddie 
force  is  here  exerted  first  on  the  laterals,  but  as  the  laterals 
move  forward  the  centrals  are  also  moved  ahead  of  them.  The 
prominence  given  to  the  upper  lip  by  so  doing  was  not  in  this 
case  objectionable  for  the  upper  lip  was  not  sufficiently  prom- 
inent. The  occlusion  of  the  first  bicuspids  was  normal,  but  the 
lower  teeth  occluded  irregularly  against  the  cutting  edges  of 
the  upper  centrals.     The  arch  bar  was  assisted  by  a  piece  of 


144 


ORTHODONTIA. 


retaining  and  connecting  band,  Xo.  39,  which  was  punched 
and  cut  away  as  shown  in  Fig.  210,  to  fit  over  the  studs  of  the 
lateral  bands,  and  bent  to  pass  around  the  labial  surfaces  of  the 
central  incisors. 

Fie.  210. 


No  30 


The  connecting-  band  was  held  to  the  studs  of  the  lateral 
bands  by  retaining  clamp  nuts,  Xo.  38.  The  spring  action  of 
this  connecting  band  operated  to  assist  in  moving  the  laterals 


out  and  held  the  centrals  in  so  that  the  teeth  would  be  in  per- 
fect line  as  soon  as  the  laterals  had  moved  to  a  position  anterior 
to  the  cuspids.     Fig.  211  gives  the  detail  of  the  appliance. 

167.      Fig.  212   shows  the  arch  bar  as  used  to  move  the 


ARCH    l'.AK   APPLIANCES. 


H5 


lower  incisor  teeth  forward  into  line.  It  will  be  found  that  in 
moving-  forward  the  teeth  will  conform  to  the  shape  of  the  bar, 
so  by  simply  bending"  the  bar  to  the  desired  form  of  the  arch 

Fig-.  212. 


the  teeth  will  be  in  perfect  line  when  the  operation  is  com- 
pleted.   The  bands  on  the  laterals  are  No.  2  studded  bands,  and 

Fig-.  213. 


■J.Z 

their  office  is  to  prevent  the  arch  bar  slipping  up  on  the  teeth. 
It  will  be  noticed  that  bar-end  caps,  No.  34,  are  placed  on  the 
projecting  ends  of  the  arch  bar  to  prevent   irritation   of  the 


i46 


ORTHODONTIA. 


tongue.  It  is  well  to  place  these  on  the  ends  of  the  arch  bar 
when  used  on  the  upper  arch,  but  very  necessary  when  the 
arch  bar  is  used  on  the  lower.     Fig.  213  is  the  detail  drawing. 

Fig.  214. 


168.  Fig.  214  shows  an  arch  bar  operating  to  move  the 
four  lower  incisor  teeth  forward  into  line.  This  appliance 
differs  from  the  one  shown  in  Fig.  212  in  that  the  anchorage 

Fig.  215. 


is  obtained  from  the  second  bicuspid  teeth.  These  teeth  are 
banded  with  No.  47  single  socket  screw  bands.  The  detail 
is  shown  in  Fig.  215.  These  bands  are  both  placed  on  the 
teeth  with  the  recessed  openings  of  the  clutch  tubes  pointing 


ARCH    BAR  APPLIANCES. 


H7 


distally.  A  lock  nut,  No.  23,  is  first  placed  on  each  end  of  the 
bar  and  then  a  clutch  nut,  No.  22.  The  clutch  nuts  enter  the 
recessed  openings  of  the  clutch  tubes  on  the  single  socket  bands 
and  the  lock  nuts  clamp  the  tubes  firmly  against  the  clutch 
nuts.  To  operate  the  appliance  the  clutch  nuts  are  loosened 
the  proper  amount  and  the  lock  nuts  then  turned  tightly 
against  the  anterior  ends  of  the  clutch  tubes  ;  this  moves  the 
appliance  forward  and  locks  it.  The  result  is  the  same  as  that 
obtained  by  the  appliance  shown  in  Fig.  212,  but  this  illustra- 
tion serves  to  show  how  anchorage  may  be  gained  when  the 
molars  are  not  in  a  condition  to  be  used. 

Figf.  216. 


In  cases  where  the  arch  bar  is  used  inside  the  lower  arch, 
it  is  the  author's  practice  to  anchor  to  the  bicuspids  whenever 
practicable,  for  by  so  doing  the  appliance  does  not  extend  as 
far  back  on  each  side  of  the  arch  and  so  offers  less  interference 
with  the  action  of  the  tongue.  Bar-end  caps,  No.  34,  should  be 
used  on  the  short  arch  bar  as  well  as  on  the  longer  one. 

169.  In  Fig.  216  an  arch  bar  is  anchored  to  the  first  bi- 
cuspid on  the  right  side  and  the  first  molar  on  the  left.  The 
object  of  this  is  to  swing  the  left  incisors  forward.    In  the  case 


148 


ORTHODONTIA. 


illustrated  the  left  lateral  was  extracted,  since  it  stood  directly 
back  of  the  cuspid  and  the  arch  was  already  of  sufficient  size 
to  correspond  with  the  upper.  The  left  central  was  banded 
with  a  single  socket  button  band.  Xo.  n,  and  an  arch  bar  bent 
and  placed  in  position  as  shown.  "When  the  appliance  is  op- 
erated the  bar  will  press  first  against  the  left  central,  then  come 

Fie.  217. 


in  contact  with  the  right  central,  and  lastly  with  the  lateral. 
Two  clutch  nuts,  No.  22,  are  used  to  engage  the  clutch  tube 
of  the  left  molar  band,  and  one  Xo.  22  enters  the  anterior  re- 

'1  opening  of  the  single  socket  screw  bands,  Xo.  47,  which 
is  on  the  right  first  bicuspid.  A  lock  nut  is  also  placed  on  the 
arch  bar  to  operate  against  the  distal  end  of  the  clutch  tube 
of  the  left  central  band  to  prevent  the  central  slipping  back  on 
the  bar,  if  such  a  tendency  should  be  observed. 

Most  of  the  movement  is  obtained  by  operating  the  clutch 
nuts  which  engage  the  clutch  tube  of  the  molar  band,  the 
clutch  nut  which  engages  the  right  first  bicuspid  band  serving 
only  to  hold  this  end  of  the  arch  bar  in  position.  It  is  not 
to  use  a  lock  nut  at  the  right  first  bicuspid  band  in 
this  case,  but  the  nuts  at  the  clutch  tube  of  the  molar  band 


ARC  II   BAR  APPLIANCES. 


149 


should  always  be  locked.    If  it  should  be  necessary  to  move  the 
teeth  to  the  right  as  well  as  forward,  by  operating  the  lock  nut 
at  the  distal  end  of  the  clutch  tube  of  the  central  band  this  re- 
Fig.  218. 


Fig.  219. 


suit  will  be  obtained.     Fig.  217  gives  the  number  and  position 
of  each  part. 


!5o 


ORTHODONTIA. 


170.  Fig.  218  is  an  illustration  of  the  application  of  the 
arch  bar  to  the  outside  of  the  lower  arch.  In  this  case  the 
centrals  and  laterals  had,  unfortunately,  been  extracted.  The 
cuspids  had  moved  forward,  and  they  were  to  be  returned  to 
their  proper  positions  in  order  that  the  centrals  and  laterals 
might  be  bridged  in.  Screw  bands,  Xo.  50,  were  clamped  to 
the  first  molar  teeth  with  their  clutch  tubes  distally.  An  arch 
bar.  Xo.  35,  was  fitted  to  the  arch  and  single  socket  clutch 
bands  cemented  to  the  cuspids.  A  lock  nut.  No.  23,  and  a 
clutch  nut,  Xo.  22,  were  placed  on  the  arch  bar  to  engage  the 

Fie;-  220. 


clutch  tube  of  each  cuspid  band,  and  two  clutch  nuts  on  each 
end  of  the  bar  to  lock  the  arch  bar  to  the  clutch  tubes  of  the 
molar  bands.  Fig.  219  is  a  drawing  of  the  appliance;  A  show- 
ing the  detail  of  the  engagement  of  the  lock  nut  and  clutch  nut 
with  the  cuspid  bands. 

171.  In  operating  the  appliance  the  clutch  nuts  engaging 
the  molar  band-  arc  left  locked  and  the  movement  is  obtained 
by  turning  the  nut-  engaging  the  clutch  tubes  of  the  cuspid 
Land-.  The  clutch  nuts  at  the  distal  ends  of  the  tubes  are 
loosened  and  the  lock  nut-  at  the  anterior  ends  tightened.  The 
rounded  collar  of  the  clutch  nut  entering  the  recessed  opening 

of  tin-  clutch  tube  keeps  the  clutch  tube  in  position  on  the  arch 


ARCH    BAR  APPLIANCES. 


151 


bar,  the  lock  nut  locking  the  appliance  and  accomplishing  the 
backward  movement  of  the  cuspids.  The  cuspid  tooth,  there- 
fore, will  travel  back  following  the  curve  of  the  arch  bar,  and 
the  tooth  may  be  made  to  travel  in  any  desired  direction  by 
giving  the  proper  curve  to  the  bar.  It  will  be  noticed  that  in 
this  particular  case  the  curve  of  the  arch  bar  on  the  right  side 
differs  from  the  curve  on  the  left,  as  it  is  desired  to  carry  the 
left  cuspid  almost  directly  back  while  the  right  cuspid  is  to  be 
carried  obliquely  backward  and  to  the  right. 

Fisf.  221. 


172.  Fig.  220  shows  practically  the  same  operation  on  the 
upper  arch.  In  this  case  the  left  central  stands  forward  and 
at  least  half  the  width  of  the  tooth  to  the  left  of  center.  It 
is  therefore  necessary  to  move  it  to  the  right  and  into  the  arch. 
An  arch  bar  is  employed  to  accomplish  this.  The  first  molars 
are  banded,  since  they  are  sufficiently  erupted.  When  bands 
cannot  easily  be  placed  on  the  first  molars,  the  temporary  sec- 


15-  ORTHODONTIA. 

onil  molars  may  be  utilized  with  equal  advantage.  When  the 
temporary  second  molars  are  used  either  the  No.  49  double 
socket,  or  Xo.  48  single  socket,  screw  band  may  be  used.  Fig. 
221  gives  the  detail  of  the  appliance  as  illustrated  in  Fig.  220. 
A  single  socket  button  band,  No.  12  or  No.  13,  according 
to  size  of  central,  is  cemented  to  the  left  central  and  the  ce- 
ment allowed  to  harden.  A  clutch  nut,  No.  22,  and  a  lock  nut. 
No.  23,  are  employed  on  the  arch  bar  to  engage  the  clutch  tube 
of  this  band.  At  the  beginning  of  the  operation  the  nuts  en- 
gaging the  clutch  tubes  of  the  molar  bands  remain  locked  ;  the 

Fig".  222. 


lock  mil  at  the  central  band  is  loosened  about  three-fourths  of 
a  revolution,  permitting  the  central  to  be  moved  one  one- 
hundred-and-fiftieth  of  an  inch  directly  to  the  right  when  the 
nut.  Xo.  _'_'.  is  tightened  firmly  against  the  clutch  tube.  This 
method  of  tightening  is  repeated  every  second  day  until  the 
central  is  directly  opposite  the  position  it  should  take  in  the 
arch,    when    the    nut-,    engaging   its    clutch    tube   are    permitted 

to  remain  locked  and  the  nuts  at  the  clutch  tubes  of  the  molar 
bands  operated  to  draw  the  arch  bar  directly  hack  ward,  thus 
placing  the  tooth  in  the  arch.    The  tooth  is  thus  moved  first 


ARCH   BAR  APPLIANCES. 


153 


to  the  right,  and  then  posteriorly.  The  first  movement  frees 
it  from  the  lateral  which  it  overlaps.  If  the  nuts  at  the  clutch 
tube  of  the  band  on  the  central  and  those  at  the  tubes  of  the 
bands  on  the  molars  are  operated  at  the  same  time,  the  tooth 
will  be  moved  obliquely  to  the  right  and  distally.  With  this 
form  of  appliance  any  anterior  tooth  in  the  arch  can  be  moved 
in  practically  any  direction. 

Fig.  223. 

3S 


J73-  Fig-  222  shows  an  arch  bar  in  position  to  move  the 
four  upper  incisor  teeth  forward.  The  laterals  are  banded  with 
single  socket  bands,  No.  12,  and  a  lock  nut  is  placed  on  the 
arch  bar  to  rest  against  the  distal  end  of  the  clutch  tube  of  each 
lateral.  This  prevents  the  laterals  from  slipping  back  on  the 
bar  as  it  is  moved  forward.  The  molars  are  banded,  the  arch 
bar  bent  to  the  proper  shape  and  operated  by  clutch  nuts  en- 
gaging the  clutch  tubes  of  the  molar  bands  in  the  usual  man- 
ner. Fig.  223  is  the  detail  drawing  with  parts  numbered.  After 
the  four  incisors  have  been  moved  forward  until  there  is  room 
for  the  cuspids,  the   cuspids  can  be  moved  into  the  arch  by 


154 


ORTHODONTIA. 


looping  rubber  ligatures  over  the  arch  bar  and  passing  them 
around  the  cuspids. 

174.  In  the  case  shown  in  Fig.  224,  the  four  incisor  teeth 
were  in  perfect  line  and  required  only  to  be  moved  forward  a 
sufficient  distance  to  give  room  for  the  cuspids.  The  laterals 
were  banded  with  Xo.  3  studded  bands  and  the  cuspids  with 
Xo.  5  bands.  These  were  all  cemented  in  position  with  their 
studs  pointing  lingually  and  the  cement  allowed  to  harden  until 
the  next  day.  Bands,  Xo.  50,  were  then  clamped  to  the  mo- 
lars, an  arch  bar  bent  to  the  required  shape,  placed  in  position 

Fig.  224. 


^ 

£7 

1  *'*% 

' 

as  shown  and  attached  to  the  tubes  of  the  molar  bands  with  the 
nuts,  No.  22,  as  usual.  Rubbers  were  looped  over  the  arch  bar 
and  passed  around  the  cuspids  above  the  buttons  of  the  bands 
to  draw  them  into  the  arch  as  fast  as  the  four  incisors  moved 
forward.  It  will  be  found  that  the  cuspids  will  move  much 
easier  during  the  movement  of  the  incisor  teeth  than  after  the 
incisors  have  been  mined  and  in  position  some  time.  Fig.  225 
gives  the  detail  of  this  appliance.  The  manner  of  looping  the 
rubber  over  the  arch  bar  and  passing  it  around  the  cuspid  is 
shown  at  A. 


ARCH    BAR  APPLIANCES. 


155 


I75-  Fig.  226  shows  an  arch  har  inside  the  arch  with  a 
retaining  and  connecting  band  cut  and  bent  to  extend  around 
the  outside  of  the  arch,  pressing  against  the  anterior  teeth.  In 
this  case  the  centrals  are  to  be  moved  forward  and  the  laterals 
drawn  backward.  The  forces  are  equalized,  as  the  detail  draw- 
ing, Fig.  227,  shows.  No.  5  bands  are  cemented  to  the  central 
incisor  teeth  with  their  studs  labially  so  that  a  retainer  can  be 

Fig.  225. 


attached  to  these  studs  to  retain  the  teeth  without  removing 
the  bands.  No.  50  bands  are  clamped  to  the  molars  with  their 
clutch  tubes  on  the  lingual  surfaces  of  the  teeth,  and  the  long 
screws  of  these  bands  are  left  full  length  so  they  will  reach 
forward  to  connect  with  the  retaining  and  connecting  band. 
A  hole  is  punched  in  each  end  of  the  retaining  and  con- 
necting band,  No.  39,  through  which  the  long  screws  of  the 


[<6 


ORTHODONTIA. 


molar  bands  pass.  This  connecting  band  is  cut  away  as  shown 
in  Fig.  228,  the  ends  are  bent  at  right  angles  and  operated  on 
the  long  screws  of  the  molar  bands  by  screw  band  nuts.  An 
arch  bar,  Xo.  35,  is  bent  to  the  shape  of  the  arch,  two  clutch 
nuts  are  screwed  on  each  end  of  the  bar,  and  the  bar  then 
placed  in  the  position  shown  in  Fig.  226.  The  arch  bar  rests 
against  the  lingual  surfaces  of  the  incisor  teeth  between  the 
buttons  of  the  bands  and  the  gum.  As  the  arch  bar  moves 
forward  the  centrals  are  moved  out  into  line;  this  is  accom- 
plished by  loosening  the  nuts  at  the  distal  ends  of  the  clutch 
tubes  of  the  molar  bands  and  tightening  those  at  the  anterior 
ends. 

Fig.  226. 


The  laterals  arc  drawn  back  through  the  agency  of  the 
screw  band  nuts  which  engage  the  ends  of  the  connecting  band 
No.  39,  by  loosening  the  nuts  which  operate  against  the  distal 
surface  of  the  connecting  band  and  tightening  the  anterior  nuts 
until  they  are  locked.  The  force  used  to  draw  the  laterals 
back  tends  also  to  draw  the  molars  forward,  and  the  force 
used  to  move  the  centrals  forward  causes  backward  pressure 

Oil  the  molars.      Since   these   forces  counteract   each   Other,  the 

molars  are  relieved  of  nearly,  if  not  quite,  all  pressure.     If  the 


ARCH   BAR  APPLIANCES. 


157 


centrals  should  reach  their  proper  positions  before  the  laterals 
have  been  retracted,  or  the  reverse  should  occur,  the  operation 
of  one  part  of  the  appliance  may  be  stopped  and  the  other  con- 
tinned. 

Fig.  227. 


Fie.  22i 


No.  30 


Tl 


ROTATION. 


159 


CHAPTER  XIII. 


ROTATION. 


176.  The  operation  of  rotating  a  tooth  is  one  of  the  most 
difficult  in  teeth  regulation,  and  the  employment  of  piano  wire 
springs  and  like  appliances  for  the  rotation  of  teeth  is  decid- 
edly unsatisfactory,  as  the  principle  is  wrong. 

Fig.  229. 


In  Fig.  229  a  central  incisor  tooth  is  turned  on  its  axis  so 
that  it  stands  at  right  angles  to  its  normal  position.  If  this 
tooth  be  banded  and  a  hollow  pipe  soldered  to  the  labial  sur- 
face of  the  band,  a  piano  wire  spring  inserted  in  the  tube  and 
passed  around  the  arch  to  a  bicuspid  or  molar,  the  force  would 
seem  to  be  exerted  to  rotate  the  central ;  but  there  are  reallv 


i6o 


ORTHODONTIA. 


two   forces   operating,  one   to   rotate   the   tooth,   the   other   to 
tli row  it  out  of  line. 

177.  In  Fig.  230,  let  A  represent  a  tooth  standing  in  the 
position  of  the  right  central  in  Fig.  229.  To  place  this  tooth 
in  line  it  must  be  rotated  on  its  axis  until  it  is  in  the  position  B. 

Fig.  230. 


Fig.  231. 


[f  a  circle  is  drawn  at  C  the  mesial  and  distal  surfaces  of  the 
tooth  will  be  in  contact  with  the  circle  at  the  points  1)  D. 
When  the  tooth  is  being  properly  rotated  the  points  I)  D  will 
follow  the  circumference  of  the  circle  to  the  points  E  E  and 


ROTATION.  l6l 

the  tooth  will  he  in  the  position  B.  During  the  operation  the 
center,  F,  should  remain  unchanged.  Let  G  represent  a  piano 
wire  spring  passed  through  a  tube  soldered  to  the  labial  sur- 
face of  the  band  on  the  tooth  A  and  anchored  to  any  tooth 
in  the  position  H.  The  direction  in  which  the  tooth  will  be 
moved  may  be  determined  by  permitting  the  spring  to  come 
to  a  position  of  rest  while  the  end  H  is  held  immovable.  The 
experiment  will  show  that  the  tooth  A  will  have  been  moved 
to  K  when  the  spring  is  at  rest,  which  is  a  most  undesirable 
position. 

178.  If,  however,  two  forces  operate  in  opposite  direc- 
tions as  shown  in  Fig.  231,  an  entirely  different  result  will  be 
obtained.  Let  L  and  M  represent  the  two  positions  of  the 
tooth  as  shown  at  A  and  B,  Fig.  230.  Let  R  represent  the 
anchor  tooth,  S  and  T  the  opposing  forces;  S  connecting  the 
anchor  point  R  with  the  mesial  surface  of  the  tooth  and  T 
connecting  the  anchor  point,  R,  with  the  distal  surface  of  the 
tooth.  If  these  two  forces  move  equally  in  opposite  directions 
as  indicated  by  the  arrows,  the  points  N  N  will  be  moved  to 
O  O,  while  the  center  or  axis  of  the  tooth,  F,  remains  un- 
changed, which  is  the  result  desired. 

Also,  as  the  two  opposing  forces  unite  at  R  they  are  equal- 
ized and  no  strain  is  brought  to  bear  on  the  anchor  tooth. 
This  is  a  very  important  consideration. 

179.  A  tooth  may  be  rotated  in  exactly  the  manner 
shown  in  Fig.  231  by  employing  two  jack-screws,  as  illus- 
trated in  Fig.  232.  A  is  the  band  on  the  tooth  to  be  rotated 
and  F  the  band  on  the  anchor  tooth.  The  jack-screw  B  con- 
nects the  anchor  tooth  with  the  stud  of  the  band  A.  and  the 
jack-screw  C  connects  the  buttons  of  the  band  A  with  a 
single  auxiliary  T  socket  No.  31  which  is  placed  on  the  T 
bar   of   the   jack-screw   B.      When    the   jack-screw    C    is   con- 


[62 


ORTHODONTIA. 


tracted  and  B  expanded,  the  distal  surface  of  the  tooth  D 
moves  in  the  direction  indicated  by  the  arrow  G,  and  the  mesial 
surface,  E,  is  drawn  in  the  opposite  direction,  indicated  at  H. 
The  desired  rotation  is  in  this  way  accomplished,  the  distal  and 
mesial  surfaces  of  the  tooth  moving-  while  the  axis  is  unchanged. 
180.  If  the  tooth  encircled  by  the  band  A  stood  in  such 
a  position  that  the  distal  surface,  D,  should  not  be  moved  and 
the  mesial  surface,  E,  is  to  be  drawn  in  the  direction  indicated 

Fig.  232. 
H 


by  the  arrow  II.  the  jack-screw  B  must  remain  stationary, 
while  C  is  contracted.  Also,  the  mesial  surface,  E,  will  remain 
stationary  while  the  distal  surface,  I),  is  being  forced  <>ut  if 
the  iack-screw  C  is  lefl  stationary  while  the  jack-screw  B 
panded. 

Thus  it  will  be  seen  that  by  the  employment  of  two  jack- 
tooth  may  be  held  in  one  position  while  it  is  being 
rotated,  one  surface  of  the  tooth  mav  be  held  and  the  other 


ROTATION".  163 

rotated,  or  the  position  of  a  tooth   may  be  changed  entirely 
and  rotated  at  the  same  time. 

The  forces  exerted  to  accomplish  rotation  are  equalized 
through  the  Xo.  31  which  connects  the  two  jack-screws,  re- 
lieving the  anchor  tooth    from   all   strain. 

Fig.  233. 


Fig.  27,$  is  the  same  case  shown  in  Fig.  229  after  the 
operation  of  rotating  the  central  has  been  completed.  The  ap- 
pliance used  was  of  the  same  form  as  that  shown  in  Fig.  232. 

Fig.  234. 


181.  Fig.  234  shows  a  case  where  the  right  lateral  in- 
cisor is  rotated  so  that  the  mesial  surface  projects  labially, 
causing  the  tooth  to  stand  forward  and  at  right  angles  to  the 


164 


ORTHODONTIA. 


line  of  the  arch.  Fig.  235  shows  an  appliance  composed  of  two 
jack-screws  in  position  to  rotate  this  lateral.  As  the  central 
and  cuspid  were  in  contact  with  the  lateral  there  was  not 
sufficient  room  in  the  arch  for  the  lateral  without  moving 
the  central  and  cuspid  apart.  The  appliance  illustrated  exerts 
sufficient  force  to  rotate  the  lateral  and  also  force  the  adjoin- 
ing teeth  apart  to  accommodate  it.  In  this  case  it  was  neces- 
sary to  expand  the  posterior  jack-screw  and  contract  the 
anterior  one.     As  soon  as  the  distal  surface  of  the  tooth  was 

Fig.  235. 


in  line  with  the  cuspid  the  posterior  jack-screw  was  not 
tightened  further  but  was  left  locked  while  the  tightening  of 
the  anterior  jack-screw  was  continued  until  the  tooth  was  in 
its  proper  position. 

Fig.  236  gives  the  detail  of  the  construction  of  the  ap- 
pliance. The  right-hand  end  of  the  long  nut,  No.  25,  of 
the  posterior  jack-screw  was  screwed  directly  onto  the  long 
screw  of  the  molar  hand,  upon  which  had  been  previously 
placed  a  single  auxiliary  T  socket,  No.  31,  for  connection  with 
the   anterior    jack-screw,    and    a    lock    nut.    No.    23,    to   operate 

againsl  the  base  of  the  long  nut  of  the  posterior  jack-screw 
to  lock  1 1 1  i^  pari  of  the  appliance. 


ROTATION. 


165 


The  anterior  jack-screw  is  the  same  form  as  used  in  arch 
expansion.  The  T  head  of  the  No.  20  is  placed  in  the  No.  31 
and  a  double  strand  of  band  wire,  No.  30,  is  wound  around 
the  neck  of  the  No.  40,  passed  between  the  central  and  lateral 
and  attached  to  the  buttons  of  the  band  on  the  lateral.  When 
traction  is  exerted  on  this  jack-screw  the  wire  as  it  straightens 
forces  the  central  forward,  in  this  way  gaining  room  for  the 
lateral. 

Fig.  236. 


182.  Fig.  237  shows  one  method  of  rotating  a  cuspid. 
A  studded  band,  No.  5,  is  cemented  to  the  cuspid  with  the 
stud  of  the  band  on  the  lingual  surface,  as  near  as  practicable 
to  the  first  biscuspid,  a  molar  band,  No.  50,  is  clamped  to  the 
molar  tooth  and  a  stud  bar,  No.  53,  on  which  has  been  placed 
two  clutch  nuts,  No.  22,  is  attached  to  the  clutch  tube  of  the 
molar  band.  The  head  of  the  stud  bar  is  bent  so  that  it  passes 
over  the  stud  of  the  band  on  the  cuspid.    To  the  long  screw  of 


1 66 


ORTHODONTIA. 


the  molar  band  is  attached  a  short  right  and  left-hand  nut, 
No.  26.  This  nut  is  locked  at  its  base  by  a  lock  nut.  No.  23, 
and  in  its  left-hand  end  is  screwed  a  left-hand  threaded  T 
bar.  No.  40.  The  head  of  the  T  bar  is  bent  so  that  it  is  drawn 
as  near  as  possible  to  the  surface  of  the  cuspid  and  wired  to 
the  buttons  of  the  cuspid  band.  Fig.  238  shows  the  detail 
of  the  construction. 

Fig.  237. 


By  loosening  the  nut  at  the  distal  end  of  the  clutch  tube 
and  tightening  the  one  at  the  anterior  end  the  stud  bar  is  car- 
ried forward,  exerting  pressure  on  the  lingual  surface  of  the 
cuspid  to  move  in  anteriorly.  By  loosening  the  lock  nut  on 
the  long  screw  of  the  molar  band  and  turning  the  right  and 
left-hand  threaded  nut.  No.  26,  so  that  the  screw  of  the  molar 
band  and  the  left-hand  threaded  T  bar,  No.  40,  will  approach 
each  other,  the  labial  surface  of  the  cuspid  is  retracted.  The 
continuance  of  this  operation  effectually  accomplishes  the 
rotation  of  the  tooth. 

183.  Fig.  231;  shows  an  appliance  of  similar  construc- 
tion although  differing  somewhat  in  the  parts  used  to  make 
up  the  jack-screw.     The  stud  bar  is  placed  Oil   the  outside  of 


ROTATION. 


In7 


the  arch  and  the  jack-screw  on  the  inside.  In  this  case  a 
central  is  to  be  rotated,  and  a  Xo.  4  band  is  cemented  to 
the  tootli   with    the   stud   as   near   the   mesio-lingnal   angle   as 

Fig.  238. 


Fig.  239. 


practicable.     A  long  right  and  left-hand  nut,  Xo.  25,  with   a 
ball  bar.  Xo.  21,  and  a  ball  cap.  Xo.  24.  operating  in  the  left- 


1 68 


ORTHODONTIA. 


hand  end,  and  the  screw  of  the  molar  band  entering  the  right- 
hand  end,  composes  the  jack-screw.  The  rounded  head  of 
the  stud  bar  is  wired  to  the  buttons  of  the  band.  By  loosening 
the  nut  anterior  to  the  clutch  tube  of  the  molar  band  and 
tightening  the  one  posterior  the  stud  bar  is  carried  back- 
ward, tending  to  retract  the  central,  while  by  operating  the 
long  nut  of  the  jack-screw  to  expand  this  part  of  the  ap- 
pliance   the   mesial    surface   of   the    tooth   is   carried   forward. 

Fig.  240. 


These  opposing  force-  accomplish  the  rotation  of  the  tooth. 
If  it  should  be  desired  to  simply  move  the  mesial  surface  for- 
ward, and  not  retract  the  tooth,  the  stud  bar  appliance  should 
be  left  locked  during  the  operation,  the  jack-screw  effecting 
the  movement,  thus  holding  the  distal  surface  of  the  tooth 
immovable  while  the  mesial  surface  is  brought  forward.  A 
detail  of  the  appliance  with  numbers  of  the  parts  used  is  seen 

in    Fig,  240. 


ROTATION. 


iGj 


This  appliance  operates  successfully  when  the  tooth  to  be 
rotated  is  in  line  with  the  other  teeth  and  there  is  sufficient 
room  for  it  in  the  arch.  If  there  should  not  he  sufficient  room 
or  the  tooth  should  stand  inside  or  outside  the  arch  a  double 
jack-screw  should  be  used,  as  this  gives  better  control  over 
the  tooth  on  account  of  the  directions  in  which  the  opposing 
forces  operate. 

Fig.  241. 


184.  Fig.  241  shows  an  appliance  composed  of  two  jack- 
screws  anchored  to  the  biscuspid  and  molar,  engaged  in  the 
rotation  of  the  right  lateral.  When  two  or  three  teeth  are 
to  be  rotated  this  is  a  good  form  of  appliance  to  use,  as 
the  teeth  may  be  rotated  in  succession  without  changing  the 
base  of  anchorage,  and  as  a  rule  better  results  are  obtained 
by  rotating  each  tooth  separately.  In  the  case  shown  in  Fig. 
241,  a  single  socket  band,  No.  13,  is  cemented  to  the  left  first 
bicuspid  and  a  screw  band,  No.  50,  clamped  to  the  molar  with 
the  screw  projecting  anteriorly  on  the  lingual  side  of  the 
arch.  On  this  screw  is  placed  a  single  auxiliary  T  socket, 
No.  31,  and  a  clutch  nut.  No.  22,  and  lock  nut.  No.  2^,  on  the 
anterior  end  to  engage  the  clutch  tube  of  the  bicuspid  band. 


I/O 


ORTHODONTIA. 


Fig.  242  shows  the  detail  of  the  appliance.  One  jack-screw  of 
regular  form  is  seated  in  the  single  auxiliary  T  socket  which 
is  on  the  screw  of  the  molar  band  and  the  ball  cap,  No.  24,  is 
attached  to  the  stud  of  the  band  on  the  lateral.  A  second 
single  auxiliary  T  socket  is  placed  on  the  T  bar,  No.  20,  be- 

Fig.  242. 


tween  the  lock  nut  and  the  T  head.  To  this  is  attached  a 
second  jack-screw  composed  of  the  parts  as  shown  and  num- 
bered in  the  drawing.  To  the  T  head  of  the  left-hand  thread- 
ed T  bar,  No.  40.  is  attached  a  double  strand  of  band  wire, 
No.  30,  which  is  passed  around  the  distal  surface  of  the  tooth 
and  attached  to  the  buttons  of  the  band.  This  jack-screw  is 
left  locked  during  the  operation  and  serves  to  hold  the  distal 
surface  of  the  lateral  in  position  while  the  other  jack-screw 
moves  the  mesial  surface  forward,  thus  accomplishing  the  ro- 
tation.     Since    the    cuspid    needs    to    he    rotated    also,    in    this 


ROTATION. 


171 


case,  a  band  is  cemented  to  it  in  practically  the  same  position 
as  the  band  on  the  lateral,  and  the  two  jack-screws  changed 
to  operate  on  this  tooth  after  the  lateral  is  rotated.  The 
jack-screw  which  is  attached  to  the  stud  of  the  band  is  left 
locked  while  the  one  which  is  connected  to  the  buttons  of  the 
band  by  the  wire  is  operated  to  draw  the  distal  surface  of  the 
cuspid  into  the  arch  and  effect  the  rotation. 

Fig.  243. 


185.  In  cases  where  the  patient  is  less  than  sixteen  years 
of  age  a  tooth  may  be  successfully  rotated  by  using  one  jack- 
screw  and  a  rubber  ligature  as  shown  in  Fig.  243.  The  jack- 
screw  must,  of  course,  always  be  connected  to  that  angle  of 
the  tooth  which  is  to  be  moved  away  from  the  base  of  anchor- 
age, so  that  the  rubber  will  take  the  place  of  the  contracting 
jack-screw.  Fig.  244  is  a  drawing  of  a  rotating  appliance  of 
this  construction.  As  the  mesial  surface  of  the  tooth  is  to  be 
forced  ont,  the  band  is  placed  on  the  tooth  with  the  stud  as 
near  as  possible  to  the  mesio-lingual  angle  and  the  jack-screw 
connected  to  the  stud.  The  rubber  ligature,  B,  is  connected  with 
the   screw  of  the   molar  band  bv   the   silk   ligature.   C.      The 


17- 


ORTHODOXTIA. 


silk  ligature,  A,  is  connected  to  the  opposite  end  of  the  rubber, 
passed  around  the  distal  surface  of  the  tooth  and  connected  to 
the  buttons  of  the  band. 

Fig-.  244. 


No.  30 


E 


ki  um  k  i.Kivu  re 


The  amount  of  tension  given  to  the  rubber  will  regulate 
the  pressure  exerted  on  the  tooth  and  the  distal  surface  will 
be  moved  in  the  direction   indicated  by  the  arrow   I).     If  the 


ROTATION.  173 

distal  surface  of  the  tooth  should  he  in  its  proper  position 
before  the  mesial,  a  double  strand  of  band  wire,  No.  30,  should 
be  substituted  for  the  rubber  ligature.  This  will  hold  the  dis- 
tal surface  in  position  while  the  expansion  of  the  jack-screw 
is  continued. 

186.  It  is  sometimes  difficult  to  tie  the  ligature,  C,  to  the 
screw  of  the  molar  band,  and  a  hook  made  from  a  piece  of 
No.  39  and  placed  on  the  screw  of  the  molar  band  makes  a  con- 
venient attachment  for  this  end  of  the  rubber  ligature.  E,  Fig. 
244,  shows  the  shape  of  this  hook  before  it  is  bent  and  F  shows 
the  hook  in  position  with  the  rubber  attached. 

Fig-  245. 


187,  An  appliance  to  rotate  several  teeth  at  the  same  time 
is  shown  in  Fig.  245.  In  this  case  it  is  necessary  to  move  the 
left  central  forward  and  retract  the  mesial  surface  of  the  left 
lateral  to  bring  these  teeth  into  line.  A  studded  band,  No. 
3.  is  cemented  to  the  left  lateral  and  a  screw  band.  No.  50, 
clamped  to  the  molar  tooth.  A  stud  bar  bearing  a  single 
auxiliary  T  socket  and  two  clutch  nuts  is  placed  in  position 
as  shown  in  the  illustration.  The  clutch  nuts  engage  the 
clutch  tube  of  the  molar  band  and  the  head  of  the  stud  bar 
is  wired  to  the  buttons  of  the  band  on  the  lateral  bv  a  double 


174 


ORTHODONTIA. 


strand  of  band  wire  which  is  passed  around  the  mesial  surface 
of  the  tooth.  A  band.  No.  5,  is  cemented  to  the  left  central 
and  a  Xo.  3  band  to  the  right  lateral.  The  studs  of  these  bands 
are  connected  by  a  piece  of  connecting  band,  No.  39,  cut  in 
the  form  shown   at  A,   Fig.   246.    A  jack-screw,  as  shown   in 

Fig.  246. 


Fig.  240.  is  seated  in  tile  single  auxiliary  T  socket  and  the 
ball  cap  screwed  to  the  stud  of  the  band  on  the  left  central. 
This  serves  t..  attach  the  jack-screw  to  the  tooth  and  also  t<> 
clamp  the  left  end  of  tin-  connecting  hand  in  position,  while 
the  righl  end  is  held  to  the  stud  of  the  righl  lateral  hand  by 
a  retaining  clamp  nut,  No.  38. 

B3  turning  the  nuts  a1  tin-  clutch  tube  of  the  molar  hand 
-,,    thai    the    Stud    bar    i^    retracted    the    wire    is    drawn    tightly 

around  tie-  mesial  surface  <>i  the  lateral,  exerting  a  rotative 
force,  while  the  centrals  are  swung  forward  by  the  operation 


ROTATION'. 


175 


of  the  jack-screw.  The  right  lateral  is  not  moved  perceptibly 
as  it  forms  the  center  of  an  imaginary  circle  the  circumfer- 
ence of  which  is  inscribed  by  the  left  central. 

Fig.  247. 


Fig.  248. 


Each  time  the  nuts  are  turned  so  the  stud  bar  moves  back 
the  T  socket,  Xo.  31,  which  is  on  the  stud  bar  moves  with 
it  and  the  jack-screw  must  be  expanded  sufficiently  to  make  up 
for  this  before  the  incisors  will  be  moved. 


17" 


ORTHODONTIA. 


188.  Fig.  247  shows  the  same  case  with  the  jack-screw 
anchored  to  the  opposite  side  of  the  mouth  and  the  stud  bar 
dispensed  with.  A  rubber  ligature  is  looped  around  the  ball 
cap  of  the  jack-screw,  passed  between  the  central  and  lateral 
and  attached  to  the  buttons  of  the  lateral  band,  as  shown  in 
the  drawing.  Fig.  248.  A  rubber  in  this  position  exerts  force 
to  separate  the  teeth  and  to  draw  the  mesial  surface  of  the 
lateral  into  the  arch.  The  rubber  could  be  attached  to  the 
screw  of  the  molar  band  if  desired  and  would  have  the  same 
effect. 

Fig.  249. 


189.  An  appliance  to  rotate  a  right  central,  which  has  two 
separate  bases  of  anchorage  on  the  long  screw  of  the  molar 
band,  is  seen  in  Fig.  249.  In  this  case  a  Xo.  13  band  is  cement- 
ed to  the  first  bicuspid  with  the  recessed  opening  of  the  clutch 
tube  pointing  anteriorly.  A  molar  band  is  clamped  to  the  first 
molar  and  the  bicuspid  and  molar  bands  connected  by  the 
long  screw  of  the  molar  band,  on  which  have  been  placed  two 
single  auxiliary  T  socket-.  X<>.  31,  and  a  clutch  nut,  No.  22. 

The  anterior  auxiliary  Xo.  3]  rests  against  the  distal  end 
of   the    clutch    tube    <>f   the    bicuspid    band    and    when   the   nut. 


ROTATION. 


177 


No.  22,  is  turned  slightly  into  the  anterior  recessed  opening 
of  this  clutch  tube  the  No.  31  performs  the  office  of  a  lock  nut, 
holding  the  anterior  end  of  the  screw  of  the  molar  band  firmly 
in  the  tube  of  the  bicuspid  band.  A  jack-screw  of  common 
form  is  seated  in  the  single  auxiliary  T  socket  which  is  at  the 
distal  end  of  the  long  screw  of  the  molar  band,  and  has  its 
ball  cap,  No.  24,  attached  to  the  stud  of  the  band  on  the  central. 

Fig.  250. 


A  jack-screw  made  up  as  shown  at  B  Fig.  250,  has  its  left- 
hand  threaded  T  bar,  No.  40,  attached  to  the  anterior  single 
auxiliary  T  socket  and  is  connected  to  the  buttons  of  the  band 
on  the  central  by  a  double  strand  of  band  wire  which  is  looped 
through  the  rounded  head  of  the  stud  bar,  passed  around  the 
mesial  surface  of  the  tooth  and  attached  to  the  buttons.  Fig. 
250  is  a  detail  drawing  of  the  assembled  parts. 

The  T  bar  No.  20  which  is  attached  to  the  distal  T  socket 
No.  31  is  right-hand  threaded,  and  the  T  bar  No.  40,  attached 


(  ikTIluno.NTIA. 


to  the  anterior  T  socket,  is  left-hand  threaded ;  therefore,  if 
both  jack-screws  are  to  be  contracted  the  long  nuts,  No.  25 
and  Xo.  26.  must  be  turned  in  opposite  directions.     Since,  in 

Fig. 251. 


this  case,  the  distal  jack-screw  is  to  be  expanded  and  the  an- 
terior   shorter    jack-screw    is    to    be    contracted,    both    nuts 

Fig.  252. 


should  be  turned  in  the  same  direction — from  their  under 
sides  forward  toward  the  left  cuspid  tooth.  This  will  expand 
the  longer  jack-screw  and  contract  the  shorter  one. 


ROTATION.  179 

190.  Fig.  251  shows  a  rubber  used  in  place  of  the  an- 
terior jack-screw.  The  rubber  is  connected  from  the  No.  31 
which  is  on  the  screw  of  the  molar  band  to  the  buttons  of  the 
band  on  the  central.  The  forces  operate  in  the  same  direction 
and  in  many  cases  a  rubber  ligature  is  sufficient.  It  is  well 
to  try  a  rubber  first  and  if  it  does  not  exert  sufficient  pressure 
a  jack-screw  may  be  substituted.  A  drawing  of  the  appliance 
with  the  rubber  in  position  is  shown  in  Fig.  252.  A  is  the  rub- 
ber and  the  arrow  B  indicates  the  direction  of  force. 


ARCH   EXPANSION. 


181 


CHAPTER    XIV. 

ARCH   EXPANSION. 

191.  The  jack-screw  is  by  far  the  best  device  for  arch 
expansion  as  it  is  both  positive  and  intermittent  in  its  ac- 
tion and  causes  less  inconvenience  to  the  patient  while  being 
worn  than  any  other  expansion  appliance,  while  at  the  same 
time  it  is  completely  under  the  control  of  the  operator.  The 
superior  arch  may  be  widened  in  two  ways. 

Fig-  253- 


192.  First:  By  bending  the  outer  plate  of  the  alveolar 
process  by  slow  pressure,  with  a  jack-screw  extending  across 
the  mouth,  each  end  of  the  jack-screw  acting  as  anchorage  to 
move  the  opposite  end.  A.  Fig.  253,  shows  the  position  and 
inclination  of  the  teeth  before  an  operation  of  this  class;  B 
shows  the  position  of  the  teeth  after  the  operation. 


[82 


ORTHODONTIA. 


193.  Second:  The  arch  is  widened  (in  cases  of  patients 
under  sixteen  years  of  age)  by  separating  the  superior  maxil- 
lary and  palate  bones  at  the  line  of  union  of  their  palate  pro- 
cesses, and  moving  both  lateral  halves  of  the  superior  maxil- 
larv  bones  apart  the  required  distance.  A,  Fig.  254,  shows  the 
position  of  the  teeth  before  an  operation  of  this  sort  and  1> 
shows  the  processes  separated. 

Fig.  254. 


194.  As  soon  as  the  superior  maxillary  bones  commence 
to  separate  the  interdental  space  between  the  central  incisors 
will  widen  and  the  case  can  be  continued  quite  rapidly  until 
the  proper  amount  of  expansion  has  been  accomplished.  If 
the  amount  of  expansion  necessary  would  cause  the  centrals 
to  be  separated  more  than  one-sixteenth  of  an  inch,  it  is  bet- 
ter to  lock  the  appliance  when  the  centrals  have  been  separated 
this  amount  and  no  movement  permitted  for  three  or  four 
weeks.  The  patient  should  be  seen  often  to  make  sure  that 
the  lock  nut  or  bands  do  not  loosen.  The  object  of  this  is 
to  keep  the  teeth  in  absolute  resl  for  at  least  twenty-one  days. 
The  process  maj  then  be  repeated  if  more  expansion  is  neces- 
sary. 


ARCH   EXPANSION. 


I83 


195.  The  appliance  should  then  he  removed  entirely  and 
a  plaster  impression  immediately  taken  of  the  hard  palate  and 
lingual  surfaces  of  the  molars  and  bicuspids  of  each  side.  There 

Fi£-  255- 


is  no  necessity  for  including  the  crowns  of  these  teeth  in  the 
impression  and  it  is  better  to  not  do  so.  The  appliance 
should  then  be  immediately  replaced  and  worn  while  a  rubber 


plate  is  vulcanized  to  fit  the  hard  palate  and  rest  against  the 
teeth  moved.  This  retaining  plate  should  be  worn  about  six 
months. 


[84 


ORTHODONTIA. 


196.  Fig.  255  shows  an  expansion  appliance,  which  is  the 
form  most  often  used,  with  the  screws  of  the  molar  bands  on 
the  lingual  side  of  the  arch.  Single  socket  screw  bands,  No. 
47^2,  are  used  on  the  first  bicuspid  teeth  and  the  screws 
of  the  molar  bands  lie  in  the  clutch  tubes  of  these  bands.  All 
the  bands  of  this  appliance  are  screw  clamped  to  the  teeth  and 
will  stay  in  position  without  being  cemented  although  it  is 
better  to  cement  them  in  position  for  long  operations  as  it  pre- 
vents any  possibility  of  decay  starting  under  the  bands.  When 
an  appliance  with  screw  bands  cemented  is  removed  in  order 
to  take  an  impression  for  a  retaining  plate,  in  replacing  the 
appliance  to  hold  the  expansion  while  the  plate  is  being  made, 

Fig.  257. 


it  is  not  necessary  to  re-cement  the  bands.  When  button 
bands  arc  used  on  the  bicuspids  it  is  necessary  that  they 
should  be  re-cemented. 

Fig.  256  shows  the  detail  of  lb  is  appliance. 

197.  When  an  appliance  as  shown  in  Fig.  255  is  1<>  be 
placed  in  the  mouth,  proceed  as  follows:  Place  a  single  aux- 
iliary T  socket.  No.  31,  on  the  long  screw  of  each  molar  band 
s.j  the  slot  through  which  the  neck  of  the  T  bar  passes  (see 


ARCH    EXPANSION. 


i«5 


Fig-.  97),  will  point  distally  when  the  bands  are  in  position. 
Then  place  the  bands  on  the  molar  and  bicuspid  teeth  with 
the  long  screws  of  the  molar  bands  in  the  clutch  tubes  of  the 
bicuspid  bands  and  place  the  Xo.  20  in  the  T  socket  on  left 

Fig.  258. 


aannunuuuuumuui 


side  of  the  mouth  and  the  No.  40  in  the  T  socket  on  the  right 
side,   letting   the    screws    of   these   parts    pass    each    other   as 

Fig.  259. 


^ 


shown  in  Fig.  257.  Both  of  these  screws  should  be  cut  off 
with  wire  cutters  so  as  to  meet  in  the  center  of  the  arch,  as 
indicated  by  the  line  A.     The  T  bars  should   then  be  taken 


1 86  ORTHODONTIA. 

from   the  mouth   and  the  burrs  formed  by  the  wire  cutters 
should  be  removed  with  a  file. 

In  doing  this  the   screw  should  always  be  held  at  right 

Fier.  260. 


angles  to  the  file  so  the  file  will  operate  directly  on  the  end 
of    the    screw.  When    the    burr    is    entirely    removed    the 

Fig.  261. 


threaded    bars      will    enter    their     respective     ends    of     the 
long  nut,  No.  26,  freely.    When  the  T  bars  are  replaced  in  the 


ARCH   EXPANSION.  187 

round    T    sockets    their   threaded    ends    should   just   touch   as 
shown    in  Fig.  258. 

After  this  test  for  length  has  been  made  the  T  bar,  No. 
Fig.  262. 


40.  should  be  removed  from  the  round  T  socket  and  screwed 
into  the  left-hand  end  of  the  long  nut.  No.  26,  until  it  reaches 
the  center  of  the  nut.     The  molar  band  D  together  with  the 

Fig.  263. 


T  bar.  No.  20,  should  next  be  removed  and  the  right-hand  end 
of  the  long  nut  screwed  onto  the  T  bar.  No.  20,  until  the  end 
is  in  contact  in  the  center  of  the  nut  with  the  No.  40.  The 
band  D  with   the  jack-screw  attached  is  shown   in   Fig.  259. 


1 88  ORTHODONTIA. 

These  parts   should  then  be  connected   with  the  parts  which 
remain  in  the  mouth  (see  Fig.  260).  as  follows: 

198.  First,  place  the  T  head  of  the  No.  40  in  the  round 
T  socket  of  the  Xo.  31  as  shown  in  Fig.  261.  Then  swing  the 
jack-screw  and  molar  band  forward  as  shown  in  Fig.  262,  pass- 
ing the  anterior  end  of  the  screw  of  the  molar  band  into  the 
clutch  tube  of  the  left  bicuspid  band  until  the  appliance  oc- 
cupies the  position  shown  in  Fig.  263.  The  molar  band  can 
then  be  placed  on  the  left  molar  and  the  screw  band  nut 
tightened,   clamping  it  to  the   tooth.     The   appliance   is  then 

Fig.  264. 


in  position  as  shown  in  Fig.  2^^  and  is  ready  for  operation. 
Wlu-n  an  appliance  is  constructed  in  this  manner  it  ad- 
mits of  the  greatest  amount  of  expansion  and  the  jack-screw 
cannot  be  loosened  or  displaced  without  removing  one  of  the 
molar  bands  and  reversing  the  operation  just  described.  This 
precludes  all  possibility  of  the  jack-screw  being  lost  or  swal- 
lowed by  the  patient,  as  often  happens  with  the  old  form  oi 
jack-screw. 

igg.  The  case  shown  in  Fig.  -''4  is  much  more  compli- 
cated a-  it  i-  necessary  to  draw  the  bicuspids  back  until  they 
are  in  contad   with  tin-  molars,  10  move  the  laterals  forward 


ARC  1 1    EXPANSION. 


189 


to  give  room  between  the  bicuspids  and  laterals  for  the  cus- 
pids, and  to  expand  the  arch  from  the  molars  to,  and  including, 
the  laterals. 

No.  3  bands  are  cemented  to  the  laterals  with  the  studs 
projecting  lingually.  Screw  bands,  Xo.  50,  are  placed  on  the 
molars  with  their  clutch  tubes  lingually,  single  socket  bands, 
No.  13,  are  cemented  to  the  first  bicuspids,  a  stud  bar,  Xo.  53, 


Fig.  265. 


is  placed  on  each  side  of  the  arch,  each  stud  bar  bearing  a 
clutch  nut,  No.  22,  and  a  lock  nut,  Xo.  23,  to  engage  the  clutch 
tube  of  the  first  bicuspid  band,  a  single  auxiliary  T  socket, 
No.  31,  for  connecting  with  the  jack-screw  and  two  clutch 
nuts,  No.  22,  to  engage  the  clutch  tube  of  the  molar  band. 
These  stud  bars  are  connected  by  the  jack-screw  as  shown  in 
Fig.  265.  By  loosening  the  nuts  at  the  distal  ends  of  the  four 
clutch  tubes  one  revolution,  and  tightening  those  at  the  an- 


190 


ORTHODONTIA. 


terior  ends  until  they  press  firmly  against  the  tubes  to  lock 
the  appliance,  the  whole  appliance  will  be  moved  forward  one 
one-hundredth  of  an  inch.  This  increases  the  space  between 
the  laterals  and  first  bicuspids  that  amount.  The  lock  nut,  No. 
23,  should  then  be  loosened  and  the  long  nut,  No.  26,  turned 
one-half  of  a  revolution,  which  expands  the  arch  one  one- 
hundredth  of  an  inch;  the  lock  nut  should  again  be  locked 
against  the  base  of  the  long  nut.  By  doing  this  the  arch  is 
enlarged  both  laterally  and  anteriorly  one  one-hundredth  of 

Fig.  266. 


an  inch,  and  when  the  nuts  are  properly  locked  the  appliance 
holds  the  arch  firmly  at  that  position  until  it  is  again 
tightened. 

200.  It  will  be  noticed  that  in  this  case  there  was  some 
space  between  the  right  second  bicuspid  and  first  molar.  The 
nuts  engaging  the  clutch  tube  of  the  right  first  bicuspid  band 
were  tightened  more  frequently  than  the  rest  of  the  appliance 


ARCH    EXPANSION. 


191 


so  that  the  movement  of  these  teeth  would  be  more  rapid. 
201.  If  it  should  be  desirable  to  have  the  pressure  of  the 
jack-screw  exerted  close  to  the  clutch  tubes  of  the  bands  on 
the  first  bicuspids,  and  the  laterals  have  been  moved  forward 
far  enough  so  that  sufficient  space  has  been  gained  for  the 
cuspids,  the  appliance  can  be  changed,  as  shown  in  Fig.  266, 
by  removing  the  lock  nuts,  No.  23,  and  turning  the  T  sockets, 
Xo.  31,  forward  on  the  stud  bars  until  they  are  in  contact  with 

Fig.  267. 
3  Mi  $&  3 


the  distal  ends  of  the  clutch  tubes  on  the  bicuspid  bands ;  or, 
they  can  be  placed  at  the  anterior  ends  of  these  tubes  as  shown 
in  Fig.  267. 

202.  If  one  side  moves  faster  than  the  other,  or  the  an- 
terior teeth  of  one  side  should  swing  out  faster  than  those 
of  the  opposite  side,  the  jack-screw  can  be  placed  at  an  angle 
as  shown  in  Fig.  268  to  change  the  direction  of  force.  By 
simply  changing  the  position  of  the  jack-screw  any  difficulty 


192 


ORTHODONTIA. 


arising  from  the  unequal  movement  of  any  teeth  during  the 
arch  expansion  can  be  easily  overcome. 

203.  To  place  the  appliance  shown  in  Fig.  264  in  po- 
sition, first  cut  the  T  bars  so  their  ends  will  be  in  contact  as 
in  Fig.  258.  Place  the  T  bars  in  the  long  nut  No.  26  and 
connect  the  T  head  of  the  Xo.  20  with  the  No.  31  on  the  left 
stud  bar,  after  removing  the  stud  bar  and  band  from  the  mouth. 
The  bands  remaining  on  the  teeth  are  shown  in  Fig.  269.     The 

Fie.  268. 


stud  bar  with  jack-screw  attached  is  then  placed  in  position  as 
shown  in  Fig.  270.  The  rounded  head  of  the  stud  bar  is  placed 
over  the  stud  of  the  lateral  band  with  the  stud  bar  passing 
through  tlie  clutch  tube  of  tin-  bicuspid  band.  The  molar  band 
will  then  be  in  position  to  be  placed  on  the  molar  tooth  and  the 
appliance  appears  as  shown  in  big.  264.  The  nuts  which  en- 
gage tin-  lcii  !ir-l  bicuspid  band  should  then  be  turned  into 
position  the  same  as  on  the  righl   side. 


ARCH    EXPANSION. 


193 


204.  Fig.  271  shows  an  appliance  practically  the  same 
as  that  shown  in  Fig.  264  except  that  the  bands  on  the  first 
bicuspid  teeth  and   the  nuts  which  operate  against  the  clutch 

Fig.  269. 


tubes  of  these  bands  are  omitted.     In  this  case  it  is  desirable 
to  expand  the  arch  from  the  cuspid  to  the  first  molar  on  the 

Fig.  270. 


right  side,  and  from  the  lateral  to  the  first  molar  on  the  left 
side.  As  the  office  of  the  hands  in  a  case  like  this  is  to  keep 
the  stud  bar  in  one  position  so  that  the  force  of  the  jack-screw 
will  be  exerted  against  the  lingual  surfaces  of  the  teeth,  one 
band  at  the  posterior  end  and  one  at  the  anterior  end  of  each 


"'4 


ORTHODONTIA. 


stud  bar  is  sufficient.     The  bands  arc  cemented  to  the  cuspid 

and  lateral  and  the  cement  allowed  to  harden.     The  appliance 
is  then  placed  in  position  as  shown  in  the  illustration.  Fig.  271. 

Fig.  271. 


205.     If  it  should  be  desired  to  move  the  jack-screw  for- 
ward or  backward  in  the  mouth  it  can  be  easily  done  by  slip- 
Fig.  2-J2. 


ping  one  of  the  molar  bands  off  the  tooth  as  shown  in  Fig.  272 
and  moving  the  stud  bar  bark  sufficiently  to  free  the  anterior 
cud  from  the  stud,  then  revolve  the  band  and  stud  bar  iu  the 
direction  desired.  If  it  is  intended  to  move  the  jack-screw 
forward  the  baud  and  stud  bar  should  be  revolved  to  the  left. 


ARCH    EXPANSION. 


195 


and  if  backward,  to  the  right.  When  the  No.  31  has  traveled 
a  sufficient  distance  this  side  of  the  appliance  is  replaced  and 
the  position  of  the  No.  31  on  the  opposite  side  is  then  changed 
in  the  same  manner.  When  it  is  desired  to  move  each  side 
of  the  appliance  equally  the  stud  bars  should  be  given  the 
same  number  of  revolutions. 

Fig.  273. 


The  detail  of  the  appliance  is  given  in   Fig".  273. 

206.  In  cases  like  that  shown  in  Fig.  271.  where  more 
teeth  are  to  be  moved  on  one  side  than  on  the  other,  the  side 
with  the  lesser  number  of  teeth  involved  often  moves  while 
the  teeth  of  the  opposite  side  remain  stationary.  If  this  should 
occur  it  would  be  necessary  to  place  a  band  on  the  left  cuspid 
and  move  the  left  stud  bar  back  until  the  stud  of  this  band  en- 
ters the  rounded  head  of  the  stud  bar,  leaving  the  movement  of 
the  lateral  until  later  in  the  operation.  In  the  case  shown, 
the  teeth  on  the  right  side  could  advantageously  be  moved 
more  than  those  on  the  left  as  it  was  necessary  to  gain  more 
space  for  the  right  lateral  than  for  the  left. 


196 


ORTHODONTIA. 


207.  Therefore,  in  cases  where  it  is  desirable  to  move 
one  side  more  than  the  other,  by  including  one  more  tooth  in 
the  anchorage  on  the  side  which  is  to  be  moved  the  lesser  dis- 
tance, the  desired  result  can  in  most  cases  be  obtained. 

208.  Figure  274  shows  a  case  in  which  all  the  teeth  on 
the  left  side  occluded  perfectly  but  the  teeth  on  the  right  side, 
including  the  lateral,  were  all  inlocked.  In  cases  of  this  kind 
it  will  be  found  that  each  inlocked  tooth  will  afford  more 
resistance  than  its  corresponding  tooth  of  the  opposite  side. 
For  instance,  if  in  this  case  an  appliance  were  used  which 
operated  on  the  first  molar  and  two  bicuspids  of  each  side,  the 

Fig.  274. 


inlocked  molar  and  bicuspids  would  remain  stationary  while 
the  opposite  normally  occluding  teeth  would  be  moved.  The 
explanation  of  this  is  afforded  by  the  inclination  of  the  teeth, 
those  inclining  lingually  offering  greater  resistance,  from  their 
position  in  the  alveolar  process,  than  those  standing  perpen- 
dicularly, or  inclined  slightly  outward. 

209.  In  this  case  the  first  and  second  bicuspid  and  second 
molar  of  the  left  side  were  banded,  a  stud  bar  was  placed  in  the 
clutch  tubes  of  these  bands,  having  a  single  auxiliary  T  socket, 
No.  31.  on  the  stud  bar  between  the  clutch  tubes  of  the  bicus- 
pid bands.    The  lateral  of  the  right  side  was  banded  and  the 


AR(  II    EXPANSION. 


197 


ordinary  jack-screw  used  with  ball  bar.  No.  21.  and  ball  cap, 

No.  24.  to  force  it  out  of  inlock.     (See  Fig.  275  for  detail  of 

construction.) 

Fig.  275. 


210.     The    lateral    was    then    retained    by    the    appliance 
shown  in  Fig.  276.     The  band  on  the  lateral  was  reversed  so 


Fig.  276. 


A 


CP 


TJ 


No.  39 


the  stud  projected  labially  and  the  band  cemented  to  the  left 
central  with  the  stud  in  the  same  direction.  A  piece  of  con- 
necting band  Xo.  39  was  cut  as  shown  at  A  and  placed  over 
the  studs  of  the  bands  with  the  intervening  portion  resting  on 


198 


ORTHODONTIA. 


the  labial  surface  of  the  right  central.  When  a  retaining  nut 
No.  38  is  screwed  on  the  stud  of  each  band,  the  lateral  is  held  in 
position  while  the  other  teeth  are  moved. 

Fig.  277. 


Fig.  278. 


211.     A   No.  43  studded   screw  band   was  placed   on   the 
right  firsl  bicuspid,  the  jack-screw  attached  to  the  stud  of  this 


ARCH    EXPANSION.  199 

band  and  the  tooth  moved  out  into  line.  See  Fig.  2"j~j.  The 
molar  and  second  bicuspid  were  next  banded  and  with  the  ap- 
pliance detailed  in  Fig-.  2j8  these  two  teeth  were  then  moved 
into  position. 


200 


ORTHODONTIA. 


CHAPTER  XV. 


THE   SCREW    I'.AND  AS   A   REGULATING  DEVICE. 


212.  The  long  screw  of  the  molar  band  may  be  used  as 
the  prime  factor  in  minor  operations  where  the  molars  or  bi- 
cuspids are  to  he  moved  forward  or  backward  in  the  line  of  the 
arch.  Fig".  279  shows  a  screw  band  appliance  operating  to 
move  a  bicuspid  back  until  it  is  in  contact  with  the  first  molar, 
that  room  may  be  made  for  the  cuspid  to  take  its  proper  posi- 

Fig.  279. 


tion  in  the  arch.  A  single  socket  band,  No.  13,  is  cemented 
to  the  bicuspid  and  a  lock  nut,  No.  23,  and  clutch  nut,  No.  22, 
placed  on  the  long  screw  of  the  molar  band.  The  molar  band 
is  then  clamped  t'l  the  second  molar,  with  the  anterior  portion 
oi  it-  screw  entering  the  clutch  tube  of  the  bicuspid  band,  and 
is  held  in  position  b)  the  nuts.  \o.  22  and  \o.  23.  A  detail 
drawing  of  the  appliance  is  given  in   Fig.  280,  showing  a  sec- 


SCREW   HAND  AS  A   REGULATOR. 


20 1 


tion  of  the  clutch  tube  of  the  bicuspid  band  with  the  nuts,  Xo. 
22  and  Xo.  2$,  in  position. 

By  loosening  the  nut  XTo.  23  and  tightening  the  nut  Xo. 

22,  the  bicuspid  is  moved  toward  the  molar,  the  two  molars 
affording  sufficient  anchorage  to  accomplish  this.  The  clutch 
tube  of  the  molar  band  is  free  and  may  be  used  for  attachment 
to  a  jack-screw,  stud  bar,  or  any  other  appliance  that  the  case 
may  require. 

Fisr.  280. 


1  43 


213.  Fig.  281  shows  the  same  form  of  appliance  operating 
on  the  lower  teeth  with  the  long  screw  of  the  molar  band  inside 
the  arch.  A  single  socket  band.  Xo.  13,  is  cemented  to  the  first 
bicuspid  and  the  screw  band  placed  on  the  first  molar  with  the 
long  screw  passing  through  the  clutch  tube  of  the  band  on  the 
bicuspid.  The  lock  nut,  Xo.  2^,  serves  to  lock  the  appliance, 
while  the  clutch  nut,  XTo.  22,  enters  the  recessed  opening  at  the 
distal  end  of  the  clutch  tube  of  the  bicuspid  band  and  furnishes 
the  force  to  move  the  bicuspid  forward.  To  operate  the  appli- 
ance the  lock  nut  is  loosened  and  the  clutch  nut  tightened, 
which  moves  the  first  bicuspid  away  from  the  molar,  thus 
gaining  space  for  the  second  bicuspid  to  be  drawn  into  the 
arch.     This    is    generally    accomplished    by    looping   a    rubber 


2<  >2 


ORTHODONTIA. 


ligature  over  the  long  screw  of  the  molar  band,  and  passing  it 

around  the  second  bicuspid,  as  shown  in  Fig.  282.     The  cuspid 
will  also  be  moved  forward  with  the  first  bicuspid.     Very  lit- 

Fig-.28i. 


tie.  if  any,  retention  is  necessary  in  cases  of  this  kind,  for  as 
soon  as  the  bicuspid  has  been  placed  in  its  proper  position  il 
will  remain  there  without  assistance. 

Fier.  282. 


IVI  BBER  UOATURK 


214.  Sufficient  retention  is  generally  obtained  by  leaving 
tin-  appliance  in  position  for  two  or  three  weeks  after  the  teeth 
arc  in  their  proper  positions.  In  cases  where  the  second  bi- 
cuspid   is    only    partially    erupted,    if    the    adjoining    teeth    are 


SCREW   HANI)  AS  A    REGULATOR. 


203 


moved  apart  to  give  it  room  it  will  take  its  proper  position 
without  the  assistanee  of  the  rubber  ligature. 

215.     When  nuts  are  to  be  operated  on   the  lingual   sur- 
faces of  the  lower  molars  and  bicuspids  it  is  more  convenient 


Fig.  283. 


'J 


to  use   the   Special   Wrenches,   No.   70.      The   one   marked   R 

operates  on  the  right  side  and  the  one  marked  L  operates  on 

the  left  side. 

Fig.  284. 


216.  Fig.  283  shows  a  similar  appliance  used  on  the  out- 
side of  the  lower  arch.  This  also  serves  to  move  the  first 
bicuspid  forward  to  make  space  for  the  second  bicuspid.  The 
appliance  is  operated  in  the  same  way  as  that  in  Fig.  281,  and 


204  ORTHODONTIA. 

the  second  bicuspid  is  drawn  out  toward  the  screw  of  the 
molar  band  by  a  rubber  ligature,  as  shown  in  Fig.  282.  It  will 
be  noticed  that  a  bar-end  cap.  Xo.  34.  is  placed  on  the  anterior 
end  of  the  long  screw  of  the  molar  band  to  prevent  irritation 

of  the  lip. 

Fig.  285. 

D-CT    ,      V-O 

K  B  D  B  A 

As  the  nuts  in  this  appliance  are  on  the  buccal  surfaces 
of  the  lower  teeth  it  is  not  necessary  to  use  the  special 
wrenches,  Xo.  70. 

217.  Fig.  284  shows  two  screw  bands  used  in  connection 
with  a  piece  of  retaining  and  connecting  band,  No.  39,  to  move 

Fig.  286. 

Q 


the  four  incisor  teeth  forward.  No.  -'  bands  are  cemented  to 
the  laterals  with  their  studs  pointing  labially.  A  screw  band, 
Xo.  40.,  is  clamped  to  each  of  the  temporal-)  second  molars, 
with  the  screws  on  the  buccal  side  of  the  arch.  A  piece  of  re- 
taining and  connecting  band  is  cut  and  punched  to  tit  over  the 
studs  and  a  hole  punched  in  each  end  through  which  pass  the 
long  -crew-  of  the  molar  bands.     See  Fig.  -'85. 


SCREW   BAND  AS  A    REGULATOR.  205 

B  B  show  the  positions  of  the  holes  which  pass  over  the 

studs  of  the  hands  on  the  laterals.  A  A  are  the  holes  for  the 
screws  of  the  molar  bands  to  pass  through.  The  central  por- 
tion is  cut  away  at  D.  At  C  C  both  edges  of  the  No.  39  are 
cut  to  facilitate  bending.  Two  screw  band  nuts  operate 
against  each  end  of  the  connecting  band  on  the  screws  of  the 
molar  bands,  to  carry  it  forward.  A  bar-end  cap,  Xo.  34.  is 
placed  on  the  end  of  each  long  screw  to  protect  the  lip.  See 
Fig.  286.  The  clutch  tubes  of  the  molar  bands  should  also 

be  filled  smooth  with  gutta  percha  to  prevent  irritation  of  the 
tongue. 

To  operate  this  appliance  the  anterior  screw  band  nuts  are 
loosened  and  the  distal  nuts  tightened.  These  nuts  must  be 
kept  locked  firmly  against  the  connecting  band  to  prevent  the 
loss  of  movement.  In  this  particular  case  it  was  necessary 
to  tighten  the  nuts  of  the  left  side  more  than  those  of  the  right, 
as  much  more  movement  was  required  on  the  left  side  than 
on  the  right. 

An  arch  bar  appliance  used  on  the  inside  of  the  arch 
would  accomplish  this  same  result,  but  as  some  children  object 
very  decidedly  to  wearing  an  appliance  inside  the  lower  arch, 
although  willing  to  wear  one  on  the  outside,  a  choice  of  ap- 
pliances is  many  times  desirable. 


MAJOR    PROTRUSION.  20J 


CHAPTER  XVI. 

MAJOR  PROTRUSION. 

218.  There  is  probably  no  dental  irregularity  that  can  be 
so  well  classed  by  itself  and  treated  in  practically  the  same 
manner  and  with  the  same  appliance  in  every  instance  as  pro- 
trusion of  the  superior  incisor  teeth,  and  this  abnormal  con- 
dition is  met  with  very  frequently.  The  causes  which  produce 
this  condition  are  of  practical  interest  to  us  only  as  their 
determination  helps  us  to  prevent  the  condition  or  to  more 
easily  correct  it,  and  to  retain  the  teeth  after  being  moved  ; 
so  that  the  recurrence  of  the  condition  from  mechanical  or 
other  means  will  be  more  surely  prevented. 

219.  There  are  three  general  divisions  of  protrusion  of 
the  superior  incisor  teeth,  which  vary  in  their  methods  of 
treatment.  First,  those  cases  in  which  both  arches  are  normal 
in  width,  the  lower  incisors  forming  a  perfect  arch  and  giving 
proper  prominence  to  the  lower  lip,  with  a  well  developed 
chin,  the  superior  maxillary  bones  being  abnormally  large. 
This  condition  may  exist  because  the  teeth  are  larger  and 
wider  than  they  should  be  to  correspond  with  the  size  of  the 
lower,  or  because  the  molars  and  bicuspids  occlude  one-half 
step  forward  of  normal  occlusion,  thus  forming  an  unduly 
prominent  upper  jaw  with,  in  some  cases,  an  inability  to  cover 


208  ORTHODONTIA. 

the  upper  teeth  with  the  lip  without  great  effort.     A  case  of 
this  description  is  shown  in  Fig".  287. 

220.  Second,  those  cases  in  which  the  lower  teeth  form  a 
symmetrical  arch  of  normal  prominence,  the  upper  teeth  pro- 
trude as  in  the  first  division  but  the  arch  is  very  much  nar- 
rower, with  the  bicuspids  and  molars  striking  inside  the  buccal 
cusps  of  the  lower  teeth,  as  in  Fig.  288. 

221.  Third,  cases  in  which  the  upper  teeth  have  undue 
prominence,  while  the  upper  arch  may  be  either  normal  or 
narrow,  with  the  lower  jaw  receding,  thereby  causing  a  re- 
ceding lower  lip  and  chin.  A  receding  chin  mav  be  of  two  forms, 
one  having  a  normally  developed  mental  eminence,  as  shown  in 
Fig.  289,  the  other  with  a  deficient  mental  eminence,  as  shown  in 
Fig.  290.  Ideal  results  can  never  be  accomplished  in  cases  where 
the  mental  eminence  is  deficient  or  entirely  lacking,  for  there  can- 
not be  a  well-formed  face  without  a  properly  developed  chin,  even 
though  both  lips  be  of  normal  prominence. 

Happily,  the  great  majority  of  protrusion  cases  belong- 
to  the  first  division. 

222.  After  experimenting  with,  and  using  in  practical 
work,  all  the  appliances  described  by  writers  on  this  subject, 
and  carefully  taking  note  of  the  difficulties  encountered  in 
their  use  both  in  the  construction  of  the  appliance  and  the 
peculiarities  of  each  case,  the  author  has  endeavored  to  con- 
struct an  appliance  which  would  overcome,  to  the  greatest  pos- 
sible extent,  their  defects  and  one  thai  would  be  invariably  ap- 
plicable t<>  all  protrusion  cases.  Some  of  the  requirements 
of  an  appliance  lor  this  work  may  be  enumerated  as  follows: 
h  should  be  <o  constructed  that  it  may  be  immediately  adapt- 
ed to  all  cases  without  the  necessity  of  any  material  change; 
the  band-  should  be  SO  constructed  that  they  can  be  cemented 


MAJOH    PROTRUSION. 


209 


Fig.  287. 


210 


ORTHODONTIA. 


Fig1.  288. 


Fig.  289. 


M  AJOR   PROTRUSION. 


211 


Fig-.  290. 


2  1  _' 


ORTHODONTIA. 


Fig.  291. 


MAJOR    PROTRUSION.  213 

to  the  teeth  and  the  appliance  removed  from  the  mouth  at 
any  time  and  replaced   without  removing  any  of  the  bands; 

the  appliance  should  take  up  as  little  room  as  possible  and 
should  be  made  entirely  of  metal ;  all  the  force  required  to  re- 
tract the  teeth  should  be  gained  from  occipital  anchorage,  and 
this  must  be  obtained  by  means  of  a  head-cap;  the  appliance 
should  be  so  constructed  that  it  will  automatically  retain  the 
teeth  at  any  time  when  the  head-cap  is  removed,  as  it  is  very 
necessary  to  the  comfort  and  ease  of  the  patient  that  the 
head-cap  be  not  worn  while  attending  school  or  when  appear- 
ing- in  public  ;  this  should  also  be  so  constructed  that  it  can  be 
removed  or  replaced  easily  by  the  patient,  and  yet  be  held  se- 
curely in  position  while  the  pressure  is  applied  to  the  teeth. 

223.  The  appliance  which  the  author  has  found  to  most 
completely  meet  these  requirements  is  shown  in  Fig.  291. 
This  appliance  (with  the  exception  of  the  head-cap,  No.  60, 
and  the  protrusion  bow,  Xo.  58)  is  constructed  entirely  from 
the  regular  parts  of  the  author's  appliances  used  in  all  classes 
of  irregularities.  The  parts  used  are  double  socket  screw 
bands.  Xo.  50,  button  bands,  Xo.  5,  arch  bar,  Xo.  35,  lock  nuts, 
Xo.  2^,  bar-end  caps,  Xo.  34,  bar  hooks,  X"o.  55,  and  springs 
Xo.  56 :  in  combination  with  the  protrusion  bow,  No.  58,  and 
head  cap,  Xo.  60.  \Yhere  the  molar  teeth  are  small  Xo.  49 
bands  are  used  in  place  of  Xo.  50,  and  where  they  are  larger 
than  the  average  size  bands  Xo.  51  may  be  used.  In  cases 
where  the  incisors  are  small  the  Xo.  4  band  may  be  used  in- 
stead of  Xo.  5  for  attaching  to  the  anterior  teeth — central  in- 
cisors preferred. 

224.  Figure  292  shows  the  application  of  this  appliance, 
the  detail  of  which  is  most  frequently  used,  but  a  number  of 
minor  modifications  may  be  made  to  meet  any  peculiarities  in 
individual  cases  or  to  suit  the  particular  purposes  of  the  opera- 


214 


I  IK  I  !li  U)l  IX'I  I  A. 


tor.  In  this  instance  (Fig.  292)  the  hands  which  are  placed 
on  the  central  incisor  teeth  (they  may  be  placed  on  the  laterals 
or  on  all  four  teeth  if  necessary)  have  their  studs  on  the  labial 
surfaces  of  the  teeth.    The  arch  har.  Xo.  35.  is  bent  to  conform 

Fig.  292. 


to  the  shape  of  the  arch,  or  to  the  shape  of  the  desired  arch 
as  the  teeth  in  moving  back  will  conform  to  the  shape  of  the 
bar  to  a   certain   extent. 

When  the  arch  bar  is  placed  in  position  it  rests  against  the 
studs  of  the  bands  on  the  incisors.  The  object  of  these  bands  is 
to  keep  the  bar  from  slipping  up  toward  the  gum  when  pres- 
sure is  exerted  by  the  head  cap  and  protrusion  bow.  In  this 
:ase  the  arch  bar  is  placed  below  the  studs.  The  illustration 
shows  the  protrusion  bow  and  chuck  attached  to  the  arch  bar. 
The  chuck  should  always  be  placed  directly  over  the  inter- 
dental space  between  the  central  incisors,  as  shown. 


MAJOR    PROTRUSION. 


215 


225.  In  Fig.  293  the  bar  is  wired  to  the  studs  with  band 
wire,  No.  30.  The  bar  may  be  above  or  below  the  studs,  or  it 
may  be  attached  to  stud  by  a  hook  made  from  piece  of  retaining 
and   connecting  band   No.   39   (Fig.   294).   The   way  to   make 

Fig.  293. 


this  hook  is  shown  in  Fig.  295.  A  piece  of  retaining  and  con- 
necting band,  No.  39,  is  punched  at  one  end  to  pass  over  the 
stud  of  the  band  on  the  central  as  shown  at  A.  About  two- 
thirds  of  the  piece  is  cut  away  with  plate  nippers  as  at  B,  the 

Fig.  294. 


serrations  are  smoothed  and  the  narrowed  end  bent  as  at  C. 
This  hook  is  secured  to  the  stud  of  the  band  by  a  retaining 
clamp  nut,  No.  38,  as  in  Fig.  294,  and  by  using  this  easily 
constructed  device  the  bar  can  be  held  firmly  at  any  desired 
position  on  the  tooth  without  moving  the  bands. 


2l6 


ORTHODONTIA. 


226.  This  little  hook  forms  an  efficient  remedy  in  cases 
where  the  patient  persists  in  disturbing  the  arch  bar,  pulling  it 
forward  and  letting  it  snap  hack  against  the  teeth,  or  remov- 
ing it.  as  it  holds  the  bar  firmly  against  the  teeth. 

Fig.  295. 


A  B 


227.  Another  method  of  keeping  the  arch  bar  at  the  de- 
sired position  on  the  tooth  is  shown  in  Fig.  296.  This  is 
formed  by  making  a  band  of  36  gauge  20  carat  gold,  pinching 

Fig.  296. 


the  end-  together  on  the  labial  surface  of  the  tooth,  and 
soldering  with  [8  carat  gold  solder.  Then  by  cutting  trans- 
verse grooves  in  one  or  more  places  as  may  he  desired  (shown 
at  I'..  Fig.  296),  with  plate  shears,  rounding  the  bottoms  of 
these  grooves  with  a  small  rat  tail  tile,  to  receive  the  arch  bar, 
this  bar  may  ]><■  placed  near  the  gum  or  near  the  cutting  c<\^<.- 
of  the  tOOth,  as  the  operation  nia\  require.  These  grooves 
should  be  cul  tin-  full  depth  of  the  projection  so  the  arch  bar 
will  rest  against  the  entire  labial  surface  of  the  band. 


MA  [OR    PROTRUSION. 


-7'7 


228.  It  will  be  found  that  when  the  arch  bar  presses 
against  the  tip,  or  cutting  edge  of  the  tooth,  that  part  of  the 
tooth  will  be  retracted  more  rapidly  than  the  apex  of  the  root, 
which  is  desirable  in  cases  like  the  one  shown  in  Fig.  297, 
where  the  teeth  slant  forward. 

Fig.  297. 


229.  If,  however,  the  bar  is  placed  at  the  gum  line  (Fig. 
298),  the  whole  tooth  will  be  retracted,  the  apex  of  the  root 
moving  practically  as   fast  as  the  crown   of  the   tooth.     The 

Fig.  298. 


4rc>rB* 


reason  for  this  is  as  follows  :  When  the  arch  bar  is  placed  at 
the  gum  line  and  the  pressure  of  the  head-cap  applied,  the 
teeth  do  not  move  through  the  alveolar  process  but  the  whole 
process  which  contains  the  six  anterior  teeth  is  moved  back 
with  practically  all  of  the  absorption  taking  place  in  the  region 
of  the  extracted  first  bicuspid  teeth.. 


2l8  ORTHODONTIA. 

230.  A  typical  case  of  major  protrusion,  without  compli- 
cations, is  shown  in  Figs.  299  and  300.  Fig.  301  shows  the 
occlusion  of  the  upper  and  lower  teeth.  As  the  upper  first 
bicuspid  of  each  side  occludes  directly  over  the  interdental 
space  between  the  lower  cuspid  and  first  bicuspid  and  is, 
therefore,  one  step  forward,  the  upper  lip  is  prominent.  It  is 
necessary,  therefore,  to  extract  the  upper  right  and  left  first 
bicuspid  and  to  move  the  six  anterior  teeth  back  until  the 
cuspids  are  in  contact  with  the  second  bicuspids.  This  can 
be  accomplished  only  by  the  use  of  occipital  anchorage. 

The  protrusion  appliance  is  applied  to  the  upper  arch  as 
shown  in  Fig.  302.     Fig.  303  is  a  drawing  of  the  appliance. 

231.  Gold  bands  were  made  for  the  central  incisor  teeth 
of  36  gauge  20  carat  gold.  In  fitting  the  bands  to  the  teeth 
they  are  pinched  together  on  the  labial  surface,  as  shown  at 
A.  and  the  band  is  then  removed  and  soldered  with  18  carat 
gold  solder  and  a  nick  cut  in  the  projection  for  the  reception 
of  the  arch  bar,  as  shown  at  l'>.  These  bands  are  cemented  to 
the  centrals  and  the  cement  allowed  to  harden  thoroughly. 

232.  Screw  bands.  No.  50,  are  placed  on  the  molars  with 
the  clutch  tubes  011  the  buccal  side  of  the  teeth.  The  arch  bar 
is  then  bent  to  conform  to  the  outside  of  the  arch,  resting  in 
the  nicks  in  the  central  bands  and  passing  through  the  clutch 
t  ubes  of  tbe  molar  bands. 

233.  The  bands  must  be  placed  on  the  molar  teeth  so 
that  the  clutch  tubes  are  in  line  with  the  arch  bar,  permitting 
the  arch  bar  to  work  with  perfect  freedom  through  the  tubes. 
This  is  very  important.  If  tbe  arch  bar  cramps  in  the  tubes 
the  appliance  will  not  operate  successfully.  The  molar  bands 
should  never  be  cemented  to  tbe  teeth  until  the  arch  bar  has 
been  fitted  and  tin  proper  positions  of  the  bands  determined. 
In  one  case  an  operator  placed  the  arcb  bar  in  the  clutch  tubes 


MAJOR    PROTRUSION. 

Fig,  299. 


219 


Fig-.  300. 


MAJOR   PROTRUSION.  221 

of  the  molar  bands  and  then  pinched  the  tubes  together  to  hold 
the  bar.  After  the  patient  had  worn  the  appliance  two  or 
three  months  this  operator  complained  of  the  inefficiency  of 
the  appliance,  since  little  or  no  progress  had  been  made.  The 
appliance  was  sent  for  examination  and  the  whole  trouble 
was  immediately   apparent. 

Fig.  301. 


234.  Every  complaint  of  lack  of  progress  that  has  been 
investigated  (where  the  head  cap  has  been  worn  faithfully) 
has  been  caused  by  the  operator's  failure  to  get  the  clutch 
tubes  in  proper  line  with  the  arch  bar.  This  is  easily  done  by 
placing  the  bands  loosely  on  the  molar  teeth  and  moving  the 
bands,  with  the  arch  bar  in  position,  until  the  bar  works  freely 
through  the  tubes.  The  bands  should  then  be  clamped  to  the 
teeth. 

235-  When  the  molar  bands  are  to  be  cemented  to  the 
teeth  the  arch  bar  should  be  placed  in  position  and  worn  a  few 
days  to  make  sure  that  the  arch  bar  works  freely  through  the 
tubes.    The  bands  can  then  be  cemented  to  the  teeth.    As  these 


222  ORTHODONTIA. 

appliances  generally  remain  in  the  month  several  months  this 
precludes  any  possibility  of  decay  commencing  under  the 
bands. 

236.  If  the  arch  bar  and  clutch  tubes  are  in  their  proper 
relative  positions  the  arch  bar.  when  drawn  slightly  forward 
and  released,  will  snap  back  in  place  by  the  action  of  the 
springs. 

Fig.  302. 


237.  After  the  arch  bar  is  bent  to  conform  to  the  arch 
the  distal  ends,  which  extend  back  of  the  clutch  tubes,  wdl 
need  to  be  cut  off  so  that  they  project  only  enough  to  allow 
the  bar  hool<s,  No.  55,  to  be  pressed  back-  one-sixteenth  of  an 
inch  in  order  to  disengage  them  Erom  the  clutch  tubes.  See  lb 
Fig.  304.  The  springs,  No.  56,  are  attached  to  the  bar  hooks 
and  then  wired  to  the  arch  bar  just  anterior  to  the  lock  nuts, 
Xo.  23.  The  tension  of  the  springs  is  regulated  by  turning  the 
lock  nuts  forward  or  backward  on  the  arch  bar,  and  the  press 
nrc  of  the  wire  as  it  draws  over  the  squared  surface  of  the  lock 
nnt  prevents  the  lock  nut  revolving  on  the  bar  and  changing 
the  tension  of  the  springs  while  the  appliance  is  worn. 

238.  It  i^  necessary  to  move  the  1< > -1<  nuts  forward  a  lit- 
tle from  time  io  time  as  the  case  progresses  and  the  teeth  are 


MA  [OR   PROTRUSION. 


■"3 


retracted,  in  order  to  keep  the  tension  of  the  springs  always  the 
same. 

It  is  generally  necessary  to  adjust  the  springs  once  in  two 
or  three  weeks.     To  do  this,  hook  a  curved  explorer  through 


the  loop  at  the  end  of  the  spring  to  which  is  attached  the  wire 
and  draw  the  spring  forward  until  the  wire  is  free  and  the  nut 
can  be  revolved.  This  can  be  done  with  a  wrench  or  pair  of 
foil-pliers,  and  one  or  two  revolutions  is  generally  sufficient. 

239.  It  is  very  important  that  the  springs  be  properly 
adjusted.  They  must  exert  only  sufficient  force  to  draw  the 
arch  bar  back  against  the  anterior  teeth  after  being  drawn  for- 


224  ORTHODONTIA. 

ward   to  test   the   tension   of  the  springs,  with  the  arch  har 
working  freely  through  the  clutch   tubes. 

If  the  springs  are  too  tight  the  molar  teeth  will  be  moved 
forward.      This  is  to  be  rigorously  avoided. 

The  springs  should  be  extended  only  enough  so  that  the 
coils  are  not  in  contact.  The  proper  extension  is  shown  at 
A.  Fig.  304.  At  B  and  C  it  will  be  seen  the  spring  is  extended 
to  a  greater  degree,  as  the  bar  hook,  No.  55,  is  there  shown 
drawn  back  a  sufficient  distance  to  release  it  from  the  clutch 
tube  of  the  molar  band.  If  the  operator  tightens  these  springs 
too  much  the  whole  object  of  the  appliance  is  defeated.  The 
springs  arc  simply  to  retain  during  the  day  the  amount  of 
movement  gained  at  night  by  the  head-cap  and  protrusion  bow, 
and  they  will  do  this  in  every  case  without  moving  the  molars 
forward  if  properly  adjusted. 

It  is  deplorable  to  see  cases  spoiled  by  tightening  the 
springs  too  much  when  perfect  results  could  have  been  easily 
attained  with  the  right  adjustment. 

240.  The  springs  have  a  great  advantage  over  the  rubber 
ligature  which  lias  been  used  in  this  class  of  work,  as  they 
always  exert  an  even  tension  and  will  continue  to  exert  the 
same  tension  indefinitely ,  while  a  rubber  must  be  replaced  at 
leasl  twice  a  week  and  exerts  excessive  pressure  when  first 
put  mi,  decreasing  rapidly  in  its  action  until  it  is  of  little  or 
no  value  in  a  day  or  two.  The  best  results  ran  never  be  ob- 
tained with  the  rubber  ligatures  as  the  action  should  be  as 
light  as  possible   and  always  the   same. 

241.  When  the  appliance  is  u^e<l  in  connection  with  the 
notched  gold  bands  on  the  central  incisors,  as  shown  in  Fig. 
302,  it  i^  quicker  and  easier  to  remove  the  arch  bar  and  revolve 
the  nut.  spring  and  bar  hook  of  each  side  between  the  thumb 


MAJOR   PROTRUSION. 


22  = 


31 


o 


MAJOR   PROTRUSION.  227 

and  finger  than  to  draw  the  springs  forward  and  revolve  the 
lock  nuts  with  the  appliance  in  the  month. 

242.  The  operation  of  disengaging  the  arch  bar  from  the 
clutch  tubes  of  the  molar  hands  will  be  better  understood  by 
referring  to  Fig.  304.  A  shows  the  arch  bar  secured  in  the 
clutch  tube  of  a  molar  band  by  a  bar  hook,  No.  55.  B  shows 
the  bar  hook  moved  back  until  its  rounded  collar  is  disengaged 
from  the  recessed  opening  of  the  clutch  tube.  This  releases 
the  arch  bar,  allowing  it  to  be  passed  laterally  through  the 
slot  in  the  clutch  tube  and  entirely  disengaged,  as  shown  at  C. 
To  place  the  arch  bar  in  position  the  operation  is  reversed. 

As  the  case  progresses  and  the  arch  bar  moves  back  the 
distal  ends  will  project  farther  back  of  the  clutch  tubes; 
if  these  projecting  ends  irritate  the  soft  tissues  they  should 
be  cut  shorter.  The  arch  bar  will  in  some  cases  come  into  con- 
tact with  the  bicuspid  teeth  on  both  sides  as  the  case  pro- 
gresses. This  is  due  to  the  fact  that  the  anterior  portion  of  the 
arch  is  narrower  than  the  posterior,  and  the  arch  bar,  since 
bent  to  conform  to  the  original  size  of  the  arch,  as  it  moves 
back  will  press  against  the  bicuspid  teeth  and  should  be  taken 
off  occasionally  and  widened  a  little  at  this  point  so  that  it  will 
be  free  to  move  forward  or  backward  through  the  clutch  tubes 
without  pressing  against  the  buccal  surfaces  of  the  teeth. 

243.  The  protrusion  bow,  No.  58,  used  with  this  ap- 
pliance is  shown  in  305.  This  has  a  pivoted  central  standard, 
A,  in  the  socket  of  which  the  split  chuck,  15,  is  conically  seated. 
This  chuck  is  transversely  bored  and  threaded  to  receive  the 
arch  bar,  No.  35.  In  operation  the  arch  bar  is  secured  upon 
the  teeth  as  before  described,  the  chuck  B  is  then  snapped 
onto  the  arch  bar  and  the  standard.  A,  telescoped  upon  the 
chuck  (see  Fig.  143),  which  by  cone  action  is  made  to  grip 
the  arch  bar  at  any  anterior  location — usually  a  central  posi- 


228 


OKI  HODONTIA. 


lion.  The  protrusion  bow  rocks  on  its  pivot  to  prevent  shocks 
when  the  how  ends  are  pressed  upon  by  the  pillow  or  other- 
wise (see  Fig.  144),  and  also  provides  for  unswerving  press- 
ure on  the  standard. 

To  successfully  treat  cases  of  this  class  it  is  necessary  to 
extract  the  first  bicuspid  teeth,  to  invariably  use  the  head  cap 
and  move  all  six  of  the  anterior  teeth  back  simultaneously. 
This  reduces  the  size  of  the  superior  maxillary  hones,  com- 
pletely changing  the  patient's  expression  and  making"  nearly, 
if  not  entirely,  ideal  conditions  from  the  most  pronounced 
cases  of  protruding  upper  jaws. 

Fig.  305- 


244.  Tin-  patient  can  always  place  the  head  cap,  pro- 
trusion  bow  and  chuck  in  position  and  remove  them  without 
assistance,  even  though  it  be  a  child  seven  or  eight  years  old, 
anil  will  generally  do  it  more  easily  and  quickly  than  the  par- 
ent or  operator.  It  is  necessary  For  tin-  operator  to  carefully 
instruct  tin-  patient  as  to  tin-  proper  method  of  placing  the 
chuck  on  the  arch  bar  and  two  or  three  points  must  he  remem- 
bered. 

245.  The  chuck  should  he  taken  between  the  thumb  and 
firsl  linger,  the  slol  at  one  side  directly  under  the  fn>t  finger 
and  the  -lot  at  the  opposite  side  directly  tinder  the  thumb.  The 
chuck  should  approach  the  bar  obliquely  as  shown  at  A,  Fig. 


MAJOR   PROTRUSION. 


229 


306,  one  side  should  be  sprung  onto  the  bar  first,  as  shown  at 
l'>.  and  then  by  pressing  on  the  bar  and  straightening  the  chuck- 
so  that  it  will  stand  at  right  angles  to  the  bar  the  other  side 
will  slip  over  the  bar,  as  shown  at  C.  To  remove  the  chuck, 
reverse  the  operation,  tipping  it  laterally  in  the  long  direction 
of  the  bar.     The  operator  or  patient  should  never  attempt  to 


WMMBMSMMSSM 
ARCH  BAR 


Fig.  306. 


ARCH  BAR 


ARCH  BAR 


remove  the  chuck  by  drawing  it  directly  forward  as  it  grips 
the  bar  so  firmly  that  the  latter  will  be  thrown  out  of  position 
in  this  way  without  removing  the  chuck;  but,  by  tipping  the 
chuck  with  the  ringer  and  thumb  over  the  slots  very  little 
effort  will  remove  it,  and  without  displacing  the  arch  bar.  The 
chuck  should  be  placed  on  the  arch  bar  directly  over  the  in- 
terdental space  between  the  central  incisors.  It  is  removed 
when  the  head  cap  and  protrusion  bow  are  not  worn. 


230 


ORTHODONTIA. 


246.  To  the  curved  ends  of  the  protrusion  how  are  at- 
tached elastic  rubber  bands  which  connect  it  to  the  buttons 
of  the  head  cap,  No.  60.  (Sec  Fig.  307.)  The  size  and  strength 
of  these  hands  can  be  regulated  to  suit  the  case,  a  young  pa- 
tient requiring  much  lighter  bands,  or  less  tension,  than  an 
older  one.  The  lengths  of  these  rubbers  will  have  to  he  de- 
termined in  each  case.  The  upper  rubbers  are  always  shorter 
than  the  lowers. 

Fig.  307. 


247.  By  regulating  the  tension  of  the  rubbers  the  teeth 
may  he  drawn  directly  hack,  shortened,  or  elongated,  tf  both 
upper  and  lower  rubbers  have  the  same  tension  the  teeth  will 
he  drawn  directly  hack:  if  the  upper  rubbers  have  a  greater 
tension  than  the  lowers  the  anterior  teeth  will  be  shortened; 
and  the  reverse  will  be  the  case  when  the  lower  rubbers  exert 
the  greater  pressure. 

When  it  is  desired  to  shorten  all  four  incisors  they  must  all 
be  banded,  as  otherwise,  the  handed  teeth  will  be  shortened 
while  the  others  will  remain  their  original  length. 


MAJOR   PROTRUSION.  23 1 

248.     In  cases  where  one  central  is  longer  than  the  other 

teeth  only  one  band  should  be  used  and  it  should  he  placed 

on  this  tooth.    The  tooth  will  be  shortened  and  as  soon  as  it  is 

of  the  proper  length   a  hand   should   he   placed   on  the   other 

central  and  the  tension  of  the  ruhhers  readjusted  so  they  will 

exert  equal  force. 

Fig.  308. 


249.  The  author  has  used  this  form  of  appliance  for  de- 
pressing' superior  centrals  or  laterals  when  there  was  no  pro- 
trusion to  he  reduced.  In  one  case  where  the  laterals  were 
inlocked  and  after  having  heen  moved  into  line  were  consider- 
ably longer  than  the  centrals,  they  were  both  banded  with 
studded  bands,  Xo.  3,  the  bands  were  cemented  to  the  teeth 
with  the  studs  pointing  labially,  an  arch  bar  bent  to  conform 
to  the  shape  of  the  arch  and  attached  to  the  clutch  tubes  of 
bands  on  the  first  molars  by  clutch  nuts,  Xo.  22.  A  head  cap 
fitted  with  the  upper  rubbers  only  was  worn  continuously  for 
about  two  weeks,  in  which  time  the  laterals  were  depressed 
until  they  were  slightly  shorter  than  the  centrals.  The  applica- 
tion of  the  upper  rubbers  only  is  shown  in  Fig.  308. 


-  \2 


ORTHODONTIA. 


250.  To  remove  the  bow  or  change  the  position  it  is  only 
necessary  to  detach  one  of  the  bow  ends  from  the  head  cap 
rubbers  of  that  side  and  slip  the  standard  from  the  chuck.  The 
chuck  is  then  sprung  off  the  bar  by  a  slight  lateral  movement. 

251.  To  connect  the  head  cap  with  the  protrusion  bow, 
cut  each  rubber  band  (see  Fig.  309),  to  form  a  straight  piece, 

Fig.  309. 


and  with  a  rubber-dam  punch  make  a  hole  through  the 
doubled  end  of  the  rubber  one-half  inch  from  one  end  of  each 
piece.  (See  Fig.  310.)  Place  these  over  the  buttons  of  the 
cap,  as  shown  in  Fig.  311,  the  shorter  rubbers  over  the  buttons 
nearest  the   lacing.     Then   place   the   protrusion   bow   on   the 

Fig.  310. 


chuck  and  punch  holes  in  the  other  end  of  each  <>!  the  rubbers 
at  a  point  corresponding  in  tin-  ends  of  the  bow.  Also  punch 
three  or  four  holes  above  these,  three-eighths  i<»  one-half  inch 
apart,  as  shown  in  Fig.  312,  and  the  tension  exerted  by  the 
rubbers  can  be  regulated  by  placing  the  curved  hook  of  the 
protrusion  bow  through  tin-  proper  holes  in  tin-  rubbers. 


MA|()R    PROTRUSION. 


233 


252.  The  head  cap  is  made  of  kangaroo  leather  and  silk 
cord,  and  is  light,  cool,  and  adjustable  in  all  directions.  It  has 
metal  buttons  in  the  proper  positions  for  the  attachment  of  the 
rubber  bands.  The  head  cap  is  connected  at  its  anterior  por- 
tion by  silk  lacing  and  the  size  of  the  cap  may  be  changed  by 
taking  up  or  letting  out  this  lacing. 

Fig. 311. 


253.  The  protrusion  appliance  admits  of  a  great  many 
variations  to  suit  the  different  complications  which  may  be 
found  in  protrusion  cases.  Where  the  upper  lip  protrudes, 
with  lower  lip  normal,  both  upper  first  bicuspids  occluding 
one  step  forward,  center  line  normal  and  teeth  all  in  line  (see 
paragraphs  219  and  26),  the  case  is  simple.     The  upper  first 

Fig.  312. 


bicuspid  tooth  on  each  side  should  be  extracted  and  the  ap- 
pliance used  as  shown  in  Figs.  291  and  299  without  variations. 
254.  It  is  the  practice  of  some  operators  to  extract  the 
bicuspids,  draw  the  cuspids  back  with  screw  attachments  ex- 
tending from  the  cuspids  to  the  molars,  using  the  molars  as 


234  ORTHODONTIA. 

anchorage,  and  after  the  cuspids  have  been  retracted  to  use 
the  head  cap  and  protrusion  appliance  to  retract  the  other  four 
anterior  teeth.  The  author  cannot  too  heartily  condemn  this 
practice,  for  several  reasons. 

First.  The  molars  and  second  bicuspids  will  often  move  for- 
ward, sometimes  nearly  closing  the  space  occupied  by  the 
first  bicuspids  before  the  cuspids  have  been  sufficiently  re- 
tracted. Cases  in  which  this  has  happened  and  the  object  of 
operation  defeated  have  repeatedly  come  under  the  author's 
notice. 

Second.  When  we  have  at  our  command  appliances  that 
will  move  the  anterior  teeth  back  without  moving  the  molars 
or  bicuspids  forward  there  is  no  reason  why  any  operator 
should  try  to  move  the  cuspid  teeth  back  by  simple  molar 
anchorage,  and  then  move  the  four  incisors  with  occipital 
anchorage  when  the  force  necessary  to  move  the  two  cuspids 
is  much  greater  than  the  force  required  to  move  the  four  re- 
maining teeth. 

Third.  The  best  results  could  never  be  accomplished  even 
though  the  molars  and  bicuspids  should  afford  sufficient  an- 
chorage to  move  the  cuspid,  for  it  is  not  desirable  to  move  the 
teeth  through  the  alveolar  process,  but  to  reduce  the  size  of, 
and  draw  back,  the  entire  anterior  portion  of  the  superior 
maxillary  bones  and  the  alveolar  process  containing  the  six 
anterior  teeth,  until  the  cuspids  are  in  contact  with  the  second 
bicuspids.  The  only  absorption  that  takes  place  is  between  the 
cuspids  and  second  bicuspids. 

By  keeping  this  in  mind  the  most  unsightly  cast's  can  be 
changed   to  the   ideal   by   the   use  of  this  one   simple   appliance 
which  i--  easily  and  comfortably  worn  by  the  patient,  and  prob 
ably  less  trouble  to  the  operator  than  any  other  form  of  ap- 
pliance.    Eighty  per  cent  of  these  cases  will  not  require  at- 


MA.|f)K    PROTRUSION.  235 

tention  more  than  once  in  two  weeks,  while  in  the  use  of  any 
other  appliance  which  requires  nuts  to  be  tightened  the  patient 
must  be  seen  every  other  day. 

Fig-3!3- 


255.     It   requires   more   than   four  times  the   pressure    to 
move  any  of  the  anterior  teeth  back  that  it  does  to  move  them 
forward.     The  reason  for  this  is  obvious  ;  the  alveolar  wall  is 
built  up  of  two  hard,  bony  plates,  encircling  the  teeth  and  con- 
Fig.  314. 


taining  cellular  bony  structure.  The  plate  anterior  to  the  teeth 
stands  perpendicular  to  the  line  of  movement,  or  slanting  for- 
ward, which  offers  little  resistance  to  the  teeth  when  moved 
anteriorly.  The  posterior  plate  acts  as  a  brace  (see  Fig.  313). 
extending:  from  the  necks  of  the  teeth  backward,  resisting-  to 


23< ' 


ORTHODONTIA. 


the  greatest  degree  any  movement  of  the  teeth  posteriorly. 
This  bony  plate  is  not  absorbed  but  is  bent  upon  itself  when 
the  teeth  are  moved  back,  as  shown  in  Fig.  314.  This  is  ex- 
actly a  condition  to  be  desired,  as  the  flat  surface  of  the  hard 
palate  which  so  often  is  seen  just  back  of  protruding  incisor 


teeth  is  in  this  way  tipped  to  a  position  nearer  the  perpendicu- 
lar, giving  a  better  shaped  roof  to  the  mouth  and  it  is  often 
found  that  speech  is  improved  by  this  change. 

Fig.  316. 


Jn  cases  where  the  teeth  occlude  as  shown  in  Fig.  315,  with 
the  upper  lip  normal  in  prominence  and  the  lower  lip  and  chin 
ling,  as  shown  in  Fig.289,  better  results  will  be  obtained  by 
moving  the  l«»wer  jaw  forward  and  holding  it  in  a  position  which 
will  cause  the  teeth  t<>  occlude  normally,  a-  shown  in  Fig.  316, 
than  by  extracting  the  bicuspids  and   moving  the  six  anterior 


MAJOR   PROTRUSION.  237 

teeth  back.  For,  in  these  cases  the  lower  teeth  occlude  one 
step  backward,  instead  of  the  uppers  occluding  one  step  for- 
ward. Figs.  11  and  12  illustrate  this,  Fig.  12  showing-  the  im- 
provement in  the  facial  lines  in  a  ease  of  this  class,  after  mov- 
ing the  lower  jaw  forward. 

256.     Fig.  317  is  the  profile,  showing  the  positions  of  the 
lips,  of  a  patient  eight  years  old.     In  this  case  the  first  tern- 
Fig.  317. 


porary  molars  were  still  in  position  although  one  of  them  was 
being  loosened  by  the  incoming  bicuspid.  Several  members 
of  the  family  had  extensive  protrusion  of  the  upper  jaw  and  it 
was  decided  to  correct  the  condition  in  this  case  as  early  as 
possible.  The  upper  temporary  first  molar  of  each  side  was 
extracted  and  a  protrusion  appliance  of  the  same  form  as 
that  shown  in  Fig.  299  placed  in  position. 


23,8 


ORTHODONTIA. 


The  patient  wore  the  head  cap  for  about  two  weeks  when 
the  right  permanent  first  bicuspid  was  sufficiently  erupted  to 
be  easily  extracted.  This  tooth  was  then  extracted  as  was  also 
the  first  bicuspid  of  the  opposite  side  about  two  weeks  later. 

The  arch  bar  was  placed  in  position  so  it  rested  against 
the  incisor  teeth  close  to  the  gum  line.  The  head  cap  and 
protrusion    bow    were    worn   at   night   for   about   five   months. 

Fig.  318. 


The  temporal-)  cuspids  were  then  in  contact  with  the  tem- 
porary second  molars.  The  appliance  was  removed  and  a  re- 
tainer placed  in  position. 

The  first  molars  were  connected  by  a  gold  wire  which  ex- 
tended around  the  anterior  pari  of  the  arch,  resting  in  the 
notches   ol    the  BfOld   bands  on    the   centrals.     The    retainer   was 


MAIOK    PROTRUSION. 


239 


left  in  position  for  nearly  a  year,  during  which  time  the  per- 
manent second  bicuspids  came  into  position.     Fig.  318  shows 

the  positions  of  the  lips  one  year  after  the  appliance  was  re- 
moved. The  temporal'}-  cuspids  are  still  in  position,  ft  will  be 
found  that  the  permanent  cuspids  will  take  their  positions  in 

Fig.  319- 


Fig.  320. 


the  arch  without  assistance.  Fig.  319  shows  the  positions  of 
the  upper  teeth  at  the  commencement  of  the  operation  and  Fig. 
320  their  positions  after  the  retaining  appliance  had  been  re- 
moved. 


24° 


OKI  UODONTIA. 


257-  Fig-  321  .gives  a  case  in  which  the  upper  first 
bicuspid  of  each  side  occluded  one  step  forward  and  there  was 
not  sufficient  room  between  the  cuspids  for  the  centrals  and 
laterals;  consequently,  the  right  central  was  crowded  forward 
more  than  the  other  teeth.  As  the  upper  lip  was  too  promi- 
nent and  the  first  bicuspids  were  one  step  forward,  these  teeth 
were  extracted  and  the  appliance  placed  in  position  as  shown. 
Fig.  322  is  a  drawing  of  this  appliance.  As  it  was  necessary  to 
move  the   cuspids   more   than   the  right   central   the  appliance 

Fig.  321. 


nr^s 

i        , 

M 

aIl 

yfr^k 

|W  J\ 

was  constructed  so  that  all  the  pressure  would  be  exerted  on 
the  cuspids  first.  No  bands  we're  placed  on  the  centrals.  A 
No.  [3  single  socket  hand  was  cemented  to  each  cuspid  with 
the  recessed  opening  of  each  clutch  tube  pointing  posteriorly. 
\  lock  nut.  No.  J^.  ami  clutch  nut,  No.  22,  wen-  placed  on  each 
side  of  the  arch  bar  to  engage  the  clutch  tubes  of  the  cuspid 

hands.     The  cylindrical  pari   of  the  clutch  nuts,  No.  -'-',  entered 

the  recessed  openings  of  the  clutch  tubes.  It  will  be  noted 
that  the  position  of  the  arch  bar  in  relation  to  the  incisor  teeth 
can  he  regulated  by  turning  these  nuts. 


MA  |(  )K    PR(  >  IRISH  IN. 


241 


The  appliance  should  be  first  placed  in  position  so  the  arch 
bar  is  just  free  from  the  central  incisor  so  that  when  the  chuck- 
is  placed  in  the  position  shown  in  Fig.  321  and  pressure  ap- 
plied, all  the  force  is  exerted  on  the  cuspids.  The  tension  of 
the  spring's  is  regulated  as  described  in  Paragraph  239  and  as 
the  cuspids  move  hack  and  the  arch  har  conies  in  contact  with 


the  central,  the  clutch  nuts  at  the  distal  ends  of  the  clutch 
tubes  of  the  cuspid  bands  are  loosened  and  the  lock  nuts  at  the 
anterior  ends  tightened  a  sufficient  amount  to  move  the  arch 
har  forward  so  it  is  again  free  from  the  central.  The  nuts  en- 
gaging the  clutch  tubes  of  the  cuspid  bands  must  always  lie 
kept  locked  against  the  tubes.  This  is  absolutely  necessary 
to  the  successful  operation  of  the  appliance. 

After   the    cuspids    have    moved   so   there   is   considerable 
space  between  them  and  the  laterals  the  arch  bar  may  be  per- 


242  ORTHODONTIA. 

mitted  to  come  in  contact  with  the  right  central  and  the  move- 
ment of  the  incisor  teeth  begun.  If  the  right  lateral  should 
show  a  tendency  to  crowd  in  back  of  the  central  a  rubber  liga- 
ture should  be  looped  over  the  arch  bar  and  passed  around 
the  lateral  to  draw  it  out  into  line  so  it  will  be  directly  be- 
tween the  central  and  cuspid.  Whenever  the  four  incisor  teeth 
have  not  sufficient  room  between  the  cuspids  the  cuspids 
should  be  moved  back  first  until  there  is  room  for  the  other 
teeth.  The  advantage  of  an  arch  bar  threaded  its  entire  length 
is  here  illustrated.     It  would  be  impossible  to  attach  the  cus- 

Fig.  323. 


pids  to  a  bar  and  adjust  the  appliance  easily  and  accurately 
without  using  a  bar  on  which  nuts  could  be  operated  at  any 
poinl . 

258.  Fig.  323  shows  a  case  in  which  the  center  line  is 
slightly  to  the  right  of  the  center  of  the  face,  the  bicuspid-  on 
the  left  side  occlude  one  step  forward,  and  those  on  the  right 
occlude  normally:  the  right  cuspid  also  is  in  a  normal  posi- 
tion. In  a  case  like  this  it  is  necessary  to  move  all  the  teeth 
on  the  left   side  .'interior  to  the  molar  backward,  and  also  to 


MA  |()K  PROTRUSK  IN. 


243 


draw  the  centrals  backward  and  to  the  left.  The  first  molar 
had  already  been  extracted,  so  no  additional  teeth  were  re- 
moved and  the  appliance,  a  drawing'  of  which  is  shown  in  Fig. 

Fig-  324- 


324,  was  used.  If  the  first  molar  had  been  in  position  the  first 
bicuspid  should  have  been  extracted.  .Molar  bands,  No.  50, 
were  placed  on  the  left  second  and  right  first  molar,  a  band, 
No.   13,  cemented  to  the  left  cuspid  and  an  arch  bar  bent  to 


244 


ORTHODONTIA. 


conform  to  the  shape  of  the  arch.  Two  clutch  nuts,  Xo.  22, 
were  placed  on  the  right  side  of  the  arch  bar  to  engage  the 
clutch  tube  of  the  right  molar  band,  and  a  bar  hook,  Xo.  55, 
and  a  spring,  Xo.  56,  used  on  the  left  side  to  retain  the  move- 
ment gained  by  the  head  cap.  A  nut,  Xo.  22,  and  a  lock  nut, 
Xo.  23,  were  placed  on  the  arch  bar  anterior  to  the  spring  to 
operate  against  the  clutch  tube  of  the  single  socket  band  on  the 
cuspid.     The  object  of  this  is  to  hold  the  arch  bar  forward  so 

Fug-  325. 


that  it  will  not  press  against  the  centrals  until  the  left  cuspid 
and  bicuspids  have  been  retracted  sufficiently  to  give  room. 
The  chuck  is  gem-rally  placed  in  the  center,  but  can  be  placed 
nearer  tin-  cuspid  by  bending  the  bar,  as  shown  at  A,  Fig.  324. 
Tin-  spring,  Xo.  56,  is  adjusted  as  usual  in  such  cases,  the 
tension  being  only  sufficient  to  retain  during  the  day  the  move- 
ment gained  at  night  by  the  use  of  the  head  cap  and  protrusion 
bow. 

259.  (  )ne -half  of  the  arch  bar  may  be  used  as  illustrated 
in  Fig.  325.  This  is  of  advantage  in  a  case  where  a  differenl 
form   of  appliance   is  necessary   on   the  opposite   side  oi    the 


MA  TOR  PROTRUSION. 


^45 


mouth,  since  both  appliances  can  he  operated  without  inter- 
ference. A  single  socket  band,  Xo.  13,  is  cemented  to  the  right 
central  and  a  No.  50  band  placed  on  the  right  molar.  The 
anterior  end  of  the  arch  bar  is  attached  to  the  right  central 
band  by  a  clutch  nut.  No.  22,  and  a  lock  nut.  No.  23.  The 
chuck   is  placed  between   the  centrals   and  the  head   cap  and 

Fig.  326. 


protrusion  bow  worn  at  night.  A  bar  hook.  No.  55,  and  spring, 
No.  56,  are  used  to  retain,  as  usual.  Fig.  326  is  the  detail 
drawing,  in  which  the  band  is  shown  on  the  left  central. 

260.  In  the  case  shown  in  Fig.  327  the  central  incisors 
occlude  normally  with  the  lowers.  The  cuspids  and  laterals 
have  been  crowded  forward  by  the  bicuspids,  which  erupted 
nearly  the  width  of  a  bicuspid  forward.    As  the  upper  lip  would 


246 


ORTHODON' 


not  admit  of  any  more  prominence  it  was  necessary  to  extract 
the  upper  right  and  left  first  bicuspid  (these  are  in  position  in 
the  illustration),  and  to  move  the  cuspids  and  laterals  back 
until  they  occluded  properly  in  relation  to  the  lowers  and 
were  in  line  with  the  upper  centrals.  In  cases  like  this  where 
four  teeth  are  to  be  retracted  it  is  always  better  to  use  oc- 
cipital anchorage.  An  appliance  was  placed  in  the  mouth  as 
shown  in  the  illustration.  This  appliance  is  composed  of  the 
same  parts  as  that  shown  in  Fig.  $22. 

Fig.  327. 


Bands  were  cemented  to  the  cuspids  and  nuts  placed  in 
position  on  the  arch  bar  to  engage  their  clutch  tubes.  'These 
nuts  are  adjusted  so  that  the  arch  bar  is  in  contact  with  the 
laterals  and  remains  in  this  position  throughout  the  operation. 
It  is  not  necessary  to  readjust  the  bar  as  the  laterals  should 
move  with  the  cuspids.  By  having  the  appliance  in  ibis  posi- 
tion the  force  i1-  exerted  equally  on  cuspids  and  Laterals  and 
not  transmitted  from  the  laterals  to  the  cuspids  as  would  be 
the  <asc  it  there  were  no  bands  on  the  cuspids  connected  to 
the  arch  bar.  These  teeth  can  be  moved  back  successfully 
without    displacing  the  centrals. 


MA  FOR  PROTRUSION. 


247 


The  advantage  of  placing  bands  on  the  cuspids  in  such 
cases  cannot  be  too  strongly  emphasized. 

261.  It  will  be  noticed  that  the  cuspids  in  this  case  should 
be  rotated  to  some  extent  to  occupy  normal  positions  in  rela- 
tion to  the  curve  of  the  arch.  This  is  accomplished  by  placing 
both  of  the  nuts  which  engage  the  clutch  tube  anterior  to  the 
tube  when  the  retraction  of  the  cuspids  has  been  nearly  corn- 
Fig.  328. 
A 


pleted.  One  of  the  nuts  is  turned  against  the  anterior  end  of 
the  tube  and  the  second  nut  turned  tightly  against  the  first  to 
lock  them.  See  B,  Fig.  328.  By  so  doing  the  pressure  is  all 
exerted  on  the  anterior  end  of  the  tube  and  as  the  tube  is  slot- 
ted the  arch  bar  will  move  laterally  through  the  side  of  the 
tube  as  the  tooth  rotates,  shown  at  C. 

If  the  nuts  are  placed  in  the  position  shown  at  B,  Fig.  328, 
at  the  beginning  of  the  operation  the  teeth  will  be  rotated  more 
than  is  necessary  unless  the  nuts  are  changed  to  the  position 
shown  at  A  as  soon  as  sufficient  rotation  is  accomplished.  If 
this  is  done  it  would  be  necessarv  to  remove  the  cuspid  band 


248 


ORTHODONTIA. 


and  re-cement  it  with  the  clutch  tube  in  proper  relation  to  the 
arch  bar. 

262.     Figures  320..  330  and  331  show  a  case  in  which  the 
upper  first  bicuspids  occlude  one  step  forward,  the  upper  lip 

Fig.  329- 


was  very   prominent,   center  line  normal,  and  the  age  of  the 
patient  was  fourteen  years.     It  will  be  noticed  that  the  lower 

Fig"-  330. 


se<  "iid  bicuspid  on  the  righl  side  is  nol  in  proper  position,  hav- 
ing erupted  inside  ilx-  arch  because  of  lack  of  space  between  the 
molar  and  lii>t  bicuspid.  This  was  caused  by  the  early  ex- 
traction  of  the  temporary   second   molar. 


MAJOR  PROTRUSION.  249 

In  a  case  of  this  class  some  operators  have  extracted  the 
upper  cuspids  and  placed  the  centrals  and  laterals  in  line,  which 
would  complete  the  arch  but  ruins  the  expression.  This  sin  mid 
never  be  done  under  any  circumstances.  The  upper  first  bicus- 
pids should  always  be  extracted  and  the  cuspids  moved  into 
the  positions  previously  occupied  by  these  teeth.  When  this 
is  done  the  prominence  is  reduced  and  the  proper  fullness  to 
the  lip,  given  by  the  canine  eminence,  is  preserved. 

Fig.  331. 


Fig.  331  shows  the  relative  positions  of  the  upper  six  an- 
terior teeth.  The  right  cuspid  was  almost  in  contact  with 
the  central,  which  over-lapped  the  lateral  to  some  extent.  Both 
first  bicuspids  were  extracted,  an  appliance  placed  in  position 
as  shown  in  Fig.  332,  and  used  in  connection  with  the  head  cap 
and  protrusion  bow.  This  is  the  protrusion  appliance  with  the 
addition  of  bands  on  the  cuspids  and  nuts  on  the  arch  bar  to 
engage  the  clutch  tubes  of  these  bands  as  before  described. 
After  placing  the  appliance  in  position  the  nuts  engaging  the 
clutch  tubes  of  the  cuspid  bands  were  operated  so  that  the 
arch  bar  would  be  free  from  the  central  incisors  and  all   the 


25° 


ORTHODONTIA. 


force  exerted  by  the  head  cap  and  protrusion  bow  would  be 
transmitted  to  the  cuspids.     As  the  case  progressed  and  the 

arch  bar  came  in  contact  with  the  centrals  the  nuts  at  the 
distal  ends  of  the  clutch  tidies  of  the  cuspid  hands  were  loos- 
ened and  those  at  the  anterior  ends  tightened  so  as  to  move  the 
arch  liar  forward.  It  was  necessary  to  adjust  the  bar  in  this 
manner   every   second   week. 

Fig'-  33-2- 


rf 

mux  \  AJn 

Mj^jd 

W           riJ 

i^W 

^^r                                      A 

263.  As  soon  as  the  cuspids  had  moved  back  sufficiently 
to  give  room  for  the  laterals  a  studded  button  band  was 
cemented  to  each  lateral  with  the  stud  projecting  labially  and 
rubber  ligatures  looped  over  the  arch  bar  and  passed  around 
the  lateral^,  as  shown  in  Fig.  333.  These  rubbers  must  be 
very  light  at  first  so  as  to  cause  no  soreness.  The)-  may  be 
increased  in  strength  gradually.  The  rubbers  in  this  particular 
were  placed  in  position  before  there  was  quite  sufficient 
room  in  the  arch  i'or  the  laterals  ami  with  tin'  arch  bar  Eree 

from  the  centrals.  I 'p  to  this  .stage  of  the  Operation  the  posi- 
tion- of  the  centrals  had  not  hern  changed.  The  action  of  the 
rubbers  closed  the  space  between  the  centrals  as  tin-  laterals 
were  crowded  into  the  arch. 


MAJOR    PROTRUSION. 


2^1 


At  this  stage  there  was  still  insufficient  room  for  the 
laterals  so  the  rubbers  were  removed  and  the  teeth  wired  to 
the  arch  bar  with  band  wire.  No.  30.  to  retain  them  while  the 
cuspids  were  being  moved  back  farther.  It  is  not  advisable  to 
continue  the  use  of  rubber  ligatures  when  there  is  not  room  for 
the  laterals  and  they  have  been  moved  into  close  contact  with 
the  centrals  and  cuspids.  They  cannot,  of  course,  be  moved 
any  farther  until  space  is  gained  for  them  and  the  continued 
rise  of  the  rubber  ligatures  is  liable  to  elongate  them. 

Fig-  333- 


RLBBBR  LIQATLRE 


The  use  of  the  rubber  ligatures  may  be  resumed  at  inter- 
vals as  the  cuspids  are  moved  back.  This  gives  the  laterals  a 
period  of  movement  and  a  period  of  rest  which  is  better  than 

Fig.  334- 


continued  movement.  As  soon  as  the  laterals  are  in  proper  line 
with  the  centrals  and  cuspids,  retaining  clamps  Xo.  37,  and 
nuts.  Xo.  38.  should  be  placed  on  the  studs  of  the  bands  with 
the  ends  of  the  clamps  resting  on  the  centrals  and  cuspids. 
This  will  hold  the  laterals  in  position,  as  shown  in  Fig.  334. 


252  ORTHODONTIA. 

At  this  stage  of  the  operation  the  arch  har  is  allowed  to 
come  in  contact  with  the  centrals  and  the  nuts  which  engage 
the  clutch  tubes  of  the  cuspid  hands  should  he  locked  and  not 

Fig-  335- 


Fig.  336. 


operated  further  during  the  remainder  of  the  operation.      I  he 

six  anterior  teeth  will  then  be  moved  hark  simultaneously  by 
the  pressure  exerted  by  the  head  cap  and  this  should  be  con- 


MAJOR   PROTRUSION.  253 

tinned  until  the  cuspids  arc  in  contact  with  the  second  bicus- 
pids. When  this  is  accomplished  the  entire  appliance,  with 
the  exception  of  the  retaining  clamps  and  bands  on  the  laterals 
and    the    molar    bands,    should    be    removed    and    a    retaining 

wire,  as  shown  in  Fig.  335,  placed  in  position.  Fig.  336  shows 
the  case  just  described  when   completed. 

Fig.  337- 


264.  A  case  (upper  and  lower  models  occluded  shown  in 
Fig.  337)  was  presented  for  treatment  in  which  the  upper  right 
first  bicuspid  and  left  first  molar  had  been  recently  extracted. 
Fig.  338  shows  the  model  of  the  upper  arch  and  the  positions 
of  the  six  anterior  teeth.  The  upper  lip  was  very  prominent, 
the  center  line  normal  and  the  age  of  the  patient  eighteen 
years.  It  was  necessarv  to  reduce  the  prominence  of  the  upper 
jaw  the  width  of  a  bicuspid  tooth,  to  place  the  laterals  in  line, 
and  rotate  the  right  lateral. 

On  first  consideration  it  would  seem  that  no  more  teeth 
should  be  extracted  in  this  case,  that  the  six  anterior  teeth 
together  with  the  left  first  and  second  bicuspids  should  be 
moved  back  with  an  appliance  placed  as  shown  in  big.  $y).  If 
this  is  attempted  it  will  be  found  that  the  left  second  molar  will 


-'54 


ORTHODONTIA. 


not  afford  sufficient  anchorage  to  even  retain  the  five  teeth  an- 
terior to  it,  and  that  the  teeth  on  the  right  side  will  move  much 
faster  than  those  on  the  left,  which  will  change  the  position  of 
the  center  line,  moving  all  the  teeth  to  the  right  and  making 
it  necessary  to  remove  the  spring  and  har  hook  from  the  right 
side  and  lock  this  side  of  the  appliance,  by  means  of  clutch  nuts- 
placed  on  the  bar  to  engage  the  clutch  tube  of  the  molar  band, 
while  the  opposite  side  is  moved  an  equal  amount. 

The  second  molar  in  this  case  was  not  as  firmly  seated  in 
the  alveolar  process  as  is  usual. 

Fig.  3$- 


It  will  also  be  found  when  the  patient  is  eighteen  years 

old  that  the  bicuspids  will  move  very  slowly  indeed  and  that 

it  will  take  nearly  four  times  as  long  to  complete  the  case  than 

if  both  first  bicuspids  were  extracted.      Also,  the  alveolar  pro- 

ontaining  the  six  anterior  teeth   cannot   be  tipped   back 

ould  be  the  case  if  both  first  bicuspids  are  extracted,  and 
the  result  would  not  be  as  satisfactory. 

When  bicuspid-  are  to  be  moved  back  it  is  always  better 
to  band  one  of  them  with  a  single  socket  band  for  connection 


MA  |o|<    PROTRUSION. 


255 


with  the  arch  bar.  as  shown  in  Fig.  331;,  than  to  band  the  cus- 
pid. 

Therefore,  in  this  case   the   upper  left   first  bicuspid   was 

extracted  and  an  appliance  placed  in  the  mouth  as  shown  in 

Fig.  339- 


Fig.  340. 


Fig.  340.  Both  cuspids  were  banded  for  attachment  to  the  arch 
bar  and  a  single  socket  button  band  placed  on  the  left  second 
bicuspid  with  the  clutch  tube  projecting  lingually.    A  lock  nut, 


256  ORTHODONTIA. 

No.  2$,  and  clutch  nut.  No.  22,  were  placed  on  the  long  screw 
of  the  molar  hand  to  engage  the  clutch  tube  of  the  bicuspid 
band  and  lock  the  long-  screw  of  the  molar  hand  in  the  tube  of 
the  bicuspid  band,  in  this  way  reinforcing  the  anchorage  by 
locking  these  two  teeth  firmly  together.  The  appliance  was 
then  operated  in  the  same  manner  as  the  one  shown  in  Fig. 

332. 

Fig.  341. 


Alter  the  cuspids  had  been  moved  a  short  distance  the 
laterals  were  handed  and  rubber  ligatures  connected  to  the 
arch  bar,  as  shown  in  Fig,  341.  The  rubber  on  the  left  side 
was  looped  over  the  tooth  while  on  the  right  side  it  was  passed 
around  the  mesial  surface,  attaching  to  the  stud  on  the  lingual 
Surface.  Tins  rotated  the  tooth  while  it  was  being  drawn  into 
line.  As  soon  as  the  laterals  were  in  line  the  band  on  the  right 
lateral  was  removed  and  re-cemented  so  the  stud  was  on  the 
labial  surface.  As  the  hand  on  the  left  lateral  had  been  placed 
with  the  stud  pointing  labially  it  was  not  necessary  to  change 
this  hand.  Retaining  clamps  were  then  placed  in  position  to 
hold  the  laterals  in  line. 


MAJOR    PROTRUSION. 


257 


Gold  bands  were  now  placed  on  the  centrals  with  nicks  for 
the  reception  of  the  arch  bar,  and  the  bands  removed  from  the 
cuspids.  Fig.  342  shows  the  positions  of  the  teeth  at  this  time, 
with  the  retaining  clamps  on  the  laterals.  It  will  be  noticed 
that  the  cuspids  had  moved  about  half  the  required  distance. 
The  head  cap  and  protrusion  bow  were  worn  until  the  cuspids 
were  in  contact  with  the  second  bicuspids,  when  a  retaining 
appliance,  as  shown  in  Fig.  335,  was  placed  in  position.     The 

Fig.  342. 


head  cap  furnishes  all  the  force  to  move  the  teeth  and  the 
chuck  is  placed  on  the  arch  bar  at  a  position  just  anterior  to 
the  interdental  space  between  the  central  incisors. 

265.  Fig.  343  shows  the  position  of  the  lips  of  a  patient 
fifteen  years  old.  In  this  case  the  upper  teeth  slant  forward, 
as  shown  in  Fig.  345,  causing  an  abnormally  prominent  upper 
lip,  which  also  appeared  to  be  short  and  when  the  lips  were 
at  rest  barely  covered  the  gum.  Fig.  346  shows  the  upper 
cast  alone.     The  right  permanent  cuspid  had  not  yet  erupted. 

It  will  be  noticed  that  the  upper  first  bicuspids  occlude  one 
step  forward.     These  teeth  were  extracted,  the  central  incis- 


258 


ORTHODONTIA. 


ors  handed,  the  protrusion  appliance  placed  in  position,  as 
shown  in  Fig.  302,  and  the  head  cap  and  protrusion  how  em- 
ployed to  retract  the  anterior  teeth.  It  is  not  necessary  in  such 
a  case  to  wait  until  the  right  cuspid  is  in  position  as  this  tooth 

Fig.  343- 


will  take  its  proper  place  in  the  arch  without  assistance;  for, 
when  the  process  containing  the  six  anterior  teeth  is  hent  back 
the  position  of  this  unerupted  tooth,  in  relation  to  the  incisors, 
is  not  changed.     Fig.  344  shows  the  positions  of  the  lips,  and 

Fig.  344- 


Fig'  347  ,M('  occlusion  of  teeth,  after  the  operation.  Fig.  34K 
show-  the  casl  with  retaining  appliance  in  position.  A  drawing 
of  the  retaining  appliance  is  given  in  Fig.  349. 

266.     The  bands  On   the   centrals  and   molars  which   have 
been  used  with  the  protrusion  appliance  remain  in  position  For 


MAJOR    PROTRUSION. 


259 


the  attachment  of  the  retainer.  Pieces  of  threaded  bar,  C  C, 
which  have  been  left  when  cutting  off  the  ends  of  an  arch  bar, 
Stud  bar  or  the  long  screw  of  screw  bands  are  nitched  and 
soldered  to  the  ends  of  the  gold  wire,  A,  as  shown  at  P>  B.  The 
wire.  A,  is  twenty  carat  gold  and  twenty  gauge  (Brown  & 
Sharpe  Standard  Wire  Gauge). 

Fig-  345- 


Fig.  346. 


The  gold  wire,  A,  and  threaded  bars,  C  C,  should  be 
soldered  together  with  eighteen  carat  gold  at  B  B.  Two 
clutch  nuts,   No.  22,  are  used  on   each  of  the  threaded  bars. 


260 


ORTHODONTIA. 


C  C,  to  engage  the  clutch  tubes  of  the  molar  bands.  This  re- 
taining bar  is  then  placed  in  position  in  the  mouth.  As  the 
bands  on  the  incisors  are  simply  to  keep  the  bar  from  slipping 
up  and  down  on  the  teeth,  only  one  is  necessary.     One  of  the 

Fig-  347- 


Fig.  348. 


threaded  bars,  C  '  .  is  placed  in  the  clutch  tube  and  the  nuts 

tightly  locked  against  the  ends  of  the  tube.    The  oilier  end  is 
then  placed  in  the  other  clutch  tube  and  the  distal  nut  turned 


MAJOR  PROTRUSION. 


26l 


until  the  bar,  A,  rests  firmly  against  the  incisor  teeth.  The 
anterior  nut  is  then  turned  tightly  into  the  tube  locking  this 
side  of  the  retainer  also.  This  holds  the  teeth  firmly  in  position 
and  should  be  worn  for  at  least  six  months. 

Fig.  349- 


Fig.  35o. 


B 


D 


This  form  of  retainer  is  easily  placed  in  position  and 
adjusted  and  if  one  of  the  bands  should  become  loosened  the 
bar  may  be  removed  and  the  band  re-cemented  without  disturb- 
ing- the  other  bands. 


21  »2 


ORTHODONTIA. 


267.  The  soldered  joint,  1>,  may  be  dispensed  with  by 
substituting  bar-end  caps,  No.  34.  as  shown  in  Fig.  350.  The 
bar-end  cap,  B,  is  placed  on  the  wire.  A,  with  the  threaded 
portion  toward  the  end  of  the  wire.  The  end  of  the  wire  is 
then  pinched  between  the  jaws  of  pliars  to  enlarge  it  as  shown 
at  D.  This  prevents  the  bar-end  cap  being  drawn  off  the  end 
of  the  .yold  wire,  A.  When  the  threaded  bar,  C,  is  screwed 
tightly  into  the  bar-end  cap  it  jams  against  the  flattened  end 
of  the  gold  wire.  A,  and  the  parts  A  and  C  are  firmly  connected. 

Fig-351- 


268.  In  cases  of  protrusion  where  it  is  desirable  to  gain 
as  much  anchorage  as  possible  the  molars  and  bicuspids  can  be 
held  rigidly  in  their  relative  positions  by  the  addition  of  single 
sockel  hand-  cemented  to  the  second  bicuspids.  The  long 
screws  of  the  molar  bands  pass  through  the  clutch  tubes  of  the 


MA  (OK  PROTRUSION. 


263 


bicuspid  hands  and  arc  locked  firmly  with  the  clutch  nut,  No. 
22,  and  lock  nut,  No.  23.  The  detail  and  numbered  parts  are 
shown  in    Fig.  351. 

Fig-  352. 


269.  Another  modification  is  shown  in  Fig.  352.  In  this 
case  two  molars  are  locked  together  instead  of  a  bicuspid  and 
molar.  Button  bands.  Xo.  8,  are  cemented  to  the  second 
molars.  The  screw  bands  are  placed  on  the  first  molars  with 
their  screws  projecting  posteriorly  and  passing  through  the 
clutch  tubes  of  the  bands  on  the  second  molars.  Two  clutch 
nuts,  Xo.  22,  are  placed  on  the  long  screw  of  each  molar  band 
and  these  hold  both  molars  firmly  in  their  relative  positions 
when  locked  against  the  clutch  tubes  of  the  bands  on  the 
second   molars. 


264  ORTHODONTIA. 


CHAPTER  XVII. 


RETAINING  DEVICES. 


270.  It  is  just  as  important  for  teeth  to  be  retained  after 
their  positions  in  the  arch  have  been  changed  as  it  is  to  move 
them  into  their  proper  positions,  for  unless  this  is  properly 
done  there  is  no  advantage  in  moving  them.  When  a  tooth 
is  moved  through  the  alveolar  process  the  process  is  absorbed 
from  the  pressure  of  the  tooth  much  more  rapidly  than  it  is 
built  up  to  fill  the  space  occupied  by  the  tooth  before  it  was 
moved. 

To  retain  teeth  so  their  new  positions  will  be  permanent 
they  must  be  held  at  absolute  rest  until  the  alveolar  wall  is 
entirely  rebuilt.  If  any  movement  is  permitted  this  cannot 
take  place.  For  this  reason  silk  ligatures,  movable  rubber 
plates,  etc.,  are  absolutely  worthless.  The  only  place  where 
a  rubber  plate  can  be  successfully  used  is  for  the  retention  of 
arch  expansion.  It  must  then  lit  tightly  to  the  roof  of  the 
mouth  and  be  removed  only  for  cleansing. 

A  retaining  appliance  is  necessarily  much  more  simple- 
than  a  regulating  appliance.  In  all  retaining  appliances  just 
a-  few  teeth  as  possible  should  1»(-  banded  and  it  is  seldom 


RETENTION.  265 

necessary  to  band  more  than  three  teeth  (even  though  the 
operation  has  been  extensive),  if  the  bands  are  properly  con- 
nected. 

271.  The  parts,  Xo.  $-,  No.  38  and  No.  39,  Fig.  353.  were 
designed  primarily  as  retaining  devices  although  they  have 
since  proven  very  useful  in  accomplishing  the  movement  of 
teeth  in  minor  operations.    The  retaining  clamp,  No.  37,  passes 

Fig.  353- 

RETAINING  CLAMP.  NO.  37. 
RETAINING  CLAMP   NUT,  NO.  38. 


RETAINING  AND  CONNECTING  BAND.  NO.  39. 

over  the  stud  of  any  of  the  studded  bands  and  is  held  in  posi- 
tion by  the  retaining  clamp  nut.  No.  38,  as  shown  in  Fig.  354- 
The  ends.  A  A.  of  the  retaining  clamp  project  over,  and  rest 
against,  the  surfaces  of  the  adjoining  teeth.  This  is  the  form  of 
retainer  most  used.  It  is  simple  and  affords  means  for  holding 
three  teeth  in  line  while  only  one  tooth  is  banded.  It  may  be 
used  outside  or  inside  the  arch,  on  either  upper  or  lower  jaw. 
and  offers  no  inconvenience  to  the  patient  while  being  worn. 


ORTHODONTIA. 


When  a  central,  lateral  and  cuspid  arc  out  of  line  as  shown 
at  A,  Fig.  355.  the  lateral  inside  the  line  of  the  arch  and  the 
cuspid  and  central  outside,  after  being  moved  into  line  as 
shown  at  l'».  they  may  be  retained  by  simply  banding  the  lateral 

Fig-  354- 


and  placing  a  retaining  clamp,  Xo.  37,  and  nut.  Xo.  38,  on  the 
stud  of  the  band,  letting  the  ends  of  the  clamp  project  over  the 
cuspid  and  central.  The  three  teeth  will  be  held  in  line  as  well 
as  when  the  three  teeth  are  banded  and  the  bands  soldered  to- 


A 


Fig-  355- 


o 


B 


gether.  The  arrows  indicate  the  directions  in  which  the  teeth 
must  move  to  return  to  their  original  positions  and  although 
only  one  tooth  is  banded  the  tendency  of  each  tooth  to  return 
to  its  former  position  is  effectually  prevented. 

272.  The  retaining  and  connecting  band,  No.  39,  is  a 
blank  band  which  serves  to  connect  a  number  of  teeth  when 
used  in  conjunction  with  two  or  more-  studded  bands.  Retain- 
ing clamp  nuts,  No.  38,  are  employed  to  hold  it  to  the  studs 

of  the  bands  in  the  same  manner  as  the  No.  ^J  is  held. 


RETENTION.  267 

273.  When  a  piece  of  No.  39  is  to  be  prepared  to  connect 
a  number  of  teeth,  holes  should  he  punched  for  the  reception  of 
the  studs  of  the  hands  as  at  A,  Fig.  356.  A  hole  of  the  proper 
size  may  he  made  with  a  retaining  hand  punch.  No.  12.  made 
by  the  S.  S.  AYhite  Dental  Mfg.  Co.  for  this  purpose,  or  with  a 
Xo.  46  Morse  twist  drill.  If  a  hole  is  first  punched  through  the 
band  with  a  plate  punch  and  reamed  with  a  round  bur,  Xo.  6, 
or  bud  bur,  Xo.  52,  this  will  make  a  hole  of  the  proper  size  for 
the  reception  of  the  stud  of  a  band.  A  slot  may  be  formed  by 
punching  a  succession  of  holes,  as  shown  at  B.  This  allows  the 
stud  to  travel  lengthwise  of  the  connecting  band  and  is  neces- 
sary in  some  cases,  especially  when  the  holes  have  not  been 
punched  in  exactly  the  right  position  at  first. 

The  band  may  be  cut  away,  as  shown  at  C,  to  facilitate 
bending.  When  the  band  is  to  be  cut  narrower  this  should  be 
done  with  the  plate  nipping  punch,  as  shown  at  D,  and  then 
riled  smooth.  Holes  may  be  made  at  any  position  in  the  band, 
as  shown  in  Fig.  357.  A  shows  a  hole  punched  in  the  center, 
at  B,  it  is  close  to  one  edge;  the  oblong  slot  at  C  passes  ob- 
liquely across  the  band.     This  is  many  times  of  advantage. 

274.  When  a  hole  is  punched  near  one  edge  as  at  D,  an- 
other hole  near  the  opposite  edge  as  at  E,  and  the  band  cut 
away  at  R  and  H  with  plate  nipping  punch,  the  metal  con- 
necting D  and  E  will  pass  obliquely  across  the  band.  By  this 
arrangement  the  necessity  of  bending  the  band  in  the  direction 
of  its  wddth  is  many  times  obviated. 

275.  When  a  band  is  cut  narrower  with  a  plate  nipping 
punch,  as  shown  at  A.  the  serrations  left  by  the  punch  should 
be  removed  with  a  fine  file  until  the  edge  of  the  band  is  smooth 
as  shown  at  B.  It  is  better  to  have  two  files  for  this  purpose; 
one  a  flat,  Xo.  4,  three-eighths  of  an  inch  wide  and  the  other 


268 


ORTHODONTIA. 


Fig-  356. 

No  39 

Fig.  357- 

C D 

No  30 

Fig.  358. 


Fig.  359- 

S9 


RETENTION 


2(h) 


Fig.  360. 


RETENTION.  2"  I 

a  half-round  or  oval  file  three-sixteenths  of  an  inch  wide,  such 

as  jewelers  use.  When  two  teeth  are  to  be  connected  by  the 
connecting  hand,  as  shown  in  Fig.  359,  first  punch  a  hole  in 
one  end  of  the  hand,  as  at  A,  then  cut  the  hand  narrower  as  at 
B,  nearly  to  the  position  of  the  other  hole.  Let  the  stud  of 
one  hand  pass  through  the  hole  A,  then  bend  the  hand  to  its 
proper  shape  to  fit  the  teeth.  With  the  hand  resting  on  the 
stud  of  the  other  hand  mark  the  position  of  the  stud  and 
punch  the  other  hole  to  pass  over  this  stud,  as  at  C.  Then  cut 
the  hand  off  at  D  and  remove  the  serrated  edge,  B,  with  a  file. 
Round  the  square  corners  giving  the  hand  the  shape  shown  at 
E.  It  is  then  ready  to  he  placed  over  the  studs  of  the  hands 
and  held  in  position  by  retaining  clamp  nuts,  Xo.  38. 

Fig.  361. 


276.  When  a  hand  is  to  he  prepared  to  connect  two  teeth. 
with  the  ends  projecting  over  the  adjoining  teeth  as  shown  in 
Fig.  360,  punch  the  first  hole  a  sufficient  distance  from  the  end 
of  the  hand  to  allow  for  the  projection  over  the  adjoining  tooth. 
B  gives  the  position  of  the  first  hole  and  A  the  projection.  The 
band  is  then  cut  away  with  plate  nippers,  as  at  A  and  C.  The 
hole,  B,  is  placed  over  the  stud  of  one  of  the  hands  and  the  con- 
necting hand  bent  as  nearly  as  possible  to  the  required  shape, 


2-2 


ORTHODONTIA. 


the  second  hole  marked  and  punched  as  before  described.  A 
sufficient  amount  is  left  for  the  projection  and  the  other  end 
of  the  band  cut  off.  It  is  then  cut  to  the  shape  shown  at  E,  the 
serrated  edge  smoothed  with  a  rile  and  the  corners  rounded, 
as  shown  at  F.     It  is  then  ready  to  be  placed  in  position. 

Fig.  362. 


Fig.  363. 


277.  In  Fig.  361  a  retaining  clamp  is  attached  to  each  of 
the  upper  laterals  with  the  projecting  ends  resting  on  the  ad- 
jacent centrals  and  cuspids  for  the  purpose  of  holding  the 
laterals  in  line  after  they  have  been  moved  forward  out  of  in- 
lock.  In  Fig.  362  the  retaining  clamp  is  shown  attached  to  the 
lingual  surface  of  a  cuspid;  this  serves  to  hold  the  cuspid  in 
line  after  being  drawn  into  the  arch,  and  would  also  retain 
the  lateral  if  it  had  been  moved  labially. 


RETENTION. 


273 


278.  The  retaining  clamp  attached  to  the  buccal  surface 
of  a  second  bicuspid,  to  hold  it  in  line  after  it  has  been  moved 
fr»nn  an  inloeked  position,  is  shown  in  Fig.  363.  Fig.  364  gives 
one  method  of  holding  a  cuspid  in  line  after  it  has  been  moved 
lingually ;  a  retaining  clamp  having  been  placed  on  the  buccal 
surface  of  the  first  bicuspid,  the  cuspid  is  retained  by  the  an- 
terior end  of  the  clamp,  which  encircles  its  labial  surface.  This 
is  convenient  in  cases  where  the  lateral  has  yet  to  be  moved 
and  a  retaining  clamp,  if  attached  to  the  lingual  surface  of  the 
cuspid,  would  interfere  with  the  other  appliance. 


F 


364- 


279.  Fig.  365  shows  a  retaining  clamp  in  position  to  hold 
the  left  lateral  and  cuspid  in  line.  The  cuspid  has  been  moved 
into  the  arch  from  an  outstanding  position,  while  the  lateral 
had  been  moved  labially.  As  the  lateral  and  cuspid  must  move 
in  opposite  directions  to  return  to  their  original  positions,  the 
retaining  clamp  being  attached  to  the  band  on  the  lateral  holds 
this  tooth  in  line  while  the  end  which  projects  over  the  cuspid 
1  revents  this  tooth  moving  labially.  On  the  right  side  of  the 
arch  the  cuspid  and  central  had  been  moved  lingually  and  the 
lateral  labially.  Bands  were  cemented  to  cuspid  and  central 
with  the  studs  projecting  lingually.  A  piece  of  retaining  clamp, 


74 


•  iktik  )].>;>  n ;ti.\. 


No.  39,  was  cut  and  punched  as  shown  at  I",  Fig.  360.  bent  to 
the  proper  shape  and  held  in  position  by  retaining  clamp  nuts, 
No.  38.    See  Fig.  360.    One  end  of  the  connecting  band  projects 

Fig.  365. 


over  the  lingual  surface  of  the  first  bicuspid  and  the  other  over 
the  lingual  surface  of  the  left  central,  preventing  the  cuspid 
and   central  moving  labiallv  while  the  central  portion  of  the 

Fig.  366. 


connecting  band  rests  againsl  the  lingual  surface  of  the  lateral 
preventing  this  tooth  moving  labiallv.  A  drawing  of  the  re- 
taining clamp  appliance   is  also  shown. 


RETENTII  >.\. 


275 


280.  After  a  cuspid  has  been  moved  out  of  inlock  it 
should  be  retained  as  shown  in  Fig.  367.  When  it  has  been 
moved  with  a  jack-screw  the  stud  of  the  band  will  project 
lingually  and  the  hand  will  need  to  he  taken  off  the  tooth  and. 
re-cemented  with  the  stud  projecting  lahially  for  the  applica- 

Fig.  367. 


tiOn  of  the  retainer.     Retaining  clamp,  Xo.  37,  and  nut,  Xo.  38, 
are  then  attached  to  the  stud  with  the  ends  of  the  clamp  pro- 

Fig".  368. 


jecting  over  the  bicuspid  and  lateral.  This  prevents  the  tooth 
returning  to  its  original  position  and  should  he  worn  several 
months. 

281.    Fig.  368  shows  a  piece  of  band,  Xo.  39,  connecting  the 
studs  of  bands  on  first  bicuspid  and  lateral  to  hold  the  space 


-7' ' 


ORTHODONTIA. 


after  moving  these  teeth  apart  to  make  room  for  the  cuspid. 
The  connecting  band  would  also  afford  attachment  for  draw- 
ing the  cuspid  into  the  arch  by  means  of  rubber  ligatures.  Af- 
ter banding  the  cuspid  a  rubber  ligature  would  be  looped  over 
the  connecting  band  and  passed  around  the  cuspid  to  accom- 
plish this. 

Fig.  369. 


Tj 

B 

A 

■  ^~~^ 

71 

a 

Jj 

r 

) 

m 

In  cases  where  the  cuspids  are  not  yet  erupted,  if  the  first 
bicuspid  and  lateral  are  moved  apart  and  held  in  this  manner 
the  cuspids  will  generally  take  their  proper  positions  in  the 
arch  without  assistance. 

Fig.  370. 


282.  When  the  incisor  teeth  stand  in  very  irregular  posi- 
tions and  are  rotated  as  shown  in  Fig.  369,  after  they  have  been 
moved  to  their  proper  positions  it  i>  necessary  to  band  each 
tooth,  connecting  the  four  bands  with  retaining  band  as  shown 
in  Fig.  370.  This  holds  the  four  teeth  firmly  in  their  relative 
positions  and  although  all  have  been  moved,  when  connected 
they  hold  each  other  in  line. 


RETENTION. 


2/7 


283.  Fig.  371  shows  a  retaining  and  connecting  band  at- 
tached to  both  cuspids  and  the  right  central.  The  band  passes 
around  the  lingual  surface  of  the  six  anterior  teeth  and  the 
ends  project  over   the  first  bicuspids.     This   form  of  retainer 

Fig.  371. 


will  hold  the  cuspids  in  line  after  they  have  been  moved  from 
outstanding  positions  and  will  also  retain  the  laterals  or 
centrals  after  they  have  been  moved  from  inlocked  positions. 

Fig.  372. 


284.  The  retaining  clamp.  Xo.  $',  and  connecting  band, 
Xo.  39,  can  be  applied  to  the  lower  arch  to  retain  teeth  in  the 
same  manner  as  to  the  upper. 

Fig.  2>72  shows  a  retaining  clamp  holding  the  lower  left 
lateral  in  line  after  it  had  been  moved  labially.     Fig.  ^7^  shows 


278 


ORTHODONTIA. 


the  same  appliance  holding  the  second  bicuspid  in  line  after 
moving  it  buccally. 

285.     in   Fig.  374  the  four  lower  incisor  teeth  have  been 
moved  forward.     A  band  is  cemented  to  each  cuspid  with  the 

Fig.  373- 


stud  lingually.  A  piece  of  connecting  band,  No.  39,  is  cut  and 
punched  to  connect  the  studs  and  rest  against  the  lingual  sur- 
faces of  the  four  incisor  teeth.  This  serves  to  hold  the  teeth 
firmly  in  position  when  held  to  the  studs  of  the  bands  by  re- 
taining clamp  nuts,  No.  38. 

Fig.  374- 


286.     Fig.  375  is  ;i  case  in  which  the  lower  right  first  bi- 
cuspid has  been  extracted  to  allow  the  cuspid  to  be  moved  back. 


RETENTION. 


279 


Iii  this  case  the  lateral  had  been  moved  Labially  and  the  cuspid 
lingually  and  distally.  Studded  hands  were  placed  on  cuspid 
and  second  bicuspid  with  the  studs  projecting  lingually.     A 

Fig.  375- 


Fig.  376. 


A 


piece  of  connecting  hand.  Xo.  39,  was  punched  and  cut  as 
shown  at  A,  Fig'.  376.  and  held  in  position  by  two  retaining 
clamp  nuts.  Xo.  38.  This  held  the  cuspid  firmly  to  the  second 
bicuspid  and  the  anterior  projecting  end  of  the  retaining  clamp 
prevented  the  lateral  moving  lingually. 


280  ORTHODONTIA. 


CHAPTER  XVIII. 

MISCELLANEOUS  CASKS;  THEIR  CORRECTION  AND  RETENTION. 

287.  The  profile  shown  in  Fig.  377  is  a  case  in  which  the 
upper  lip  recedes  considerably.  This  is  caused  by  the  upper  an- 
terior teeth  striking  back  of  the  lowers.  In  this  case  the  upper 
teeth  closed  inside  of  the  lowers  to  such  an  extent  that  the 
lower  teeth  almost  touched  the  gum  on  the  anterior  surface  of 
the  upper  arch.  The  patient  was  twelve  years  old  and  the 
condition  was  rapidly  growing  worse.  The  angle  of  the  jaw 
was  continually  changing  from  the  action  of  the  abnormal  oc- 
clusion forcing  the  lower  jaw  and  teeth  forward. 

[f  this  case  had  been  treated  at  the  age  of  six  or  seven  the 
correction  would  then  have  occupied  only  a  few  days'  time,  and 
the  subsequent  deformity  would  have  been  prevented.  Perfect 
results  were  obtainable,  however,  at  ibis  period,  although  more 
time  and  trouble  were  necessary  in  accomplishing  the  work. 
Pig-  378  shows  a  profile  of  the  case  after  the  teeth  were  in  their 
proper  positions  and  the  retainer  removed. 

288.  Figs.  379,  380,  and  38]  show  the  occlusion  of  the 
teeth  when  the  case  came  for  treatment.  By  referring  to  Fig. 
380,  which  shows  the  lefl  side  of  the  models,  it  will  be  noticed 
thai  the  interdental  spaces  between  the  lower  cuspid,  bicuspids, 

and  molar  are  much   wider  than   they   should   be;  while  the  OC 


M  [SCELLANEOUS    CASES. 


28l 


elusion  at  the  upper  and  lower  molar  is  almost  normal.  \t  will 
thus  be  seen  that  in  addition  to  the  entire  lower  jaw  being 
forced  forward,  the  process  containing  the  lower  teeth  has  been 
enlarged  anterior-posteriorly.     If  this  condition  is  not  correct- 

Fi£-  377- 


Fig.  378. 


ed,  at  the  age  of  twenty  the  facial  lines  would  he  as  illustrated 
in  Fig.  5.  Fig.  381  shows  the  right  side.  The  upper  right  sec- 
ond bicuspid  was  just  appearing  through  the  gum. 

Fig.  382  shows  the  model  of  the  upper  teeth.     It  will  be 


282 


ORTHODONTIA. 


seen  that  the  right  lateral  has  been  crowded  some  distance  in- 
side the  arch  and  that  the  centrals  are  separated.  Both  tem- 
porary   cuspids    are    in    position.      Fig.    383    shows   the   lower 

Fig.  379- 


model.  Here  the  second  bicuspids  have  erupted,  while  the  tem- 
porary first  molars  are  still  in  position.  The  widened  inter- 
dental spaces  are  also  shown  although  they  do  not  appear  as 
wide  in  the  illustration  as  on  the  model. 

Fig.  380. 


In  treating  the  case  the  arch  bar  appliance  was  used.     A 

5  band  was  cemented  to  each  upper  lateral  with  the  stud 

projecting  lingually.     A  bite  hand  No.  [8  was  placed  on  each 


MISCELLANKOl'S     CASKS. 


283 


lower  first  molar,  as  shown  in  Fig.  384.  This  opens  the  hite  so 
that  the  tipper  teeth  may  pass  over  the  lowers  without  interfer- 
ence.    The  following  day  the  arch  bar  and  molar  hands  were 

Fig.  381. 


placed  in  position  as  shown  in  Fig.  385.    A  drawing  of  the  ap- 
pliance, with  parts  numbered,  is  given  in  Fig.  386. 

Fig.  382. 


289.  The  arch  liar  pressed  first  against  the  right  lateral, 
moving  this  tooth  forward  some  distance  before  it  came  in 
contact  with  the  left  lateral.  The  right  lateral  is  the  only  tooth 
that  is  moved  through  the  alveolar  process,  and  this  only  a 
sufficient  distance  to  brine  it  into  line  with  the  centrals.     As 


284 


ORTHODONTIA. 


soon  as  the  arch  bar  presses  against  the  four  incisor  teeth  the 
whole  process  containing  the  teeth  is  moved  forward.  It  may 
here  be  noted  that  the  two  molars  afford  sufficient  anchorage 

Fig.  383. 


to  move  the  four  teeth  and  the  process  containing'  them  for- 
ward, while  the  same  amount  of  anchorage  would  never  be 
adequate  to  move  them  hack. 

Fig.  384. 


290.  When  starting  cases  of  this  class  the  operator  must 
be  careful  to  nol  exerl  excessive  pressure  by  tightening  the 
appliance  too  much  or  too  often,  An  appliance  <>|  this  Form  is 
capable  of  exerting  fift)   pounds  pressure,  while  one  pound  is 


MISCELLANEOUS    CASES.  285 

sufficient  for  moving  the  lateral.     A  safe  rule  is:  to  move  the 
teeth  without  causing  soreness. 

291.  In  this  case  the  operation  progressed  in  a  perfectly 
satisfactory  manner  until  the  upper  teeth  were  striking  directly 
on  the  cutting-  edges  of  the  lowers,  when  the  upper  left  molar 
became  sensitive.  This  was  an  indication  of  too  much  pres>ure 
on  that  tooth,  so  the  appliance  was  not  tightened  for  a  week 
and  the  soreness  disappeared.  x\s  soon  as  the  appliance  was 
tightened  again,  however,  the  sensitiveness  returned.  This 
proved  conclusively  that  this  molar  alone  would  not  afford 
sufficient  anchorage  for  this  side  of  the  appliance  in  complet- 
ing the  forward  movement  of  the  incisors,  and  other  means 
must  be  resorted  to. 

292.  Reinforced  anchorage  must  be  obtained  without  re- 
moving the  appliance  now  in  position.  To  do  this  a  single 
socket  band  Xo.  47  was  cemented  to  each  of  the  first  bicuspid 
teeth  with  the  clutch  tube  on  the  buccal  surface  of  the  tooth  and 
the  recessed  opening  of  the  clutch  tube  pointing  distally.  The 
cement  was  allowed  to  harden  until  the  next  day,  when  a 
second  arch  bar  was  placed  in  position  as  shown  in  Fig.  387. 
A  detail  drawing  of  both  appliances  is  shown  in  Fig.  388. 

As  soon  as  this  second  arch  bar  was  in  position  the  strain 
was  transferred  to  it  to  relieve  the  other  arch  bar  and  take  the 
pressure  from  the  molar,  by  passing  a  double  strand  of  band 
wire  Xo.  30  around  the  laterals  beneath  the  studs,  and  twist- 
ing it  tightly  over  the  arch  bar  which  extended  around  the 
labial  surfaces  of  the  teeth.  The  clutch  nuts  Xo.  22  at  the  distal 
ends  of  the  clutch  tubes  of  the  bicuspid  bands  were  loosened 
and  the  lock  nuts  at  the  anterior  ends  tightened,  to  move  this 
arch  bar  forward.  In  this  way  pressure  was  exerted  on  the 
laterals,  relieving  the  molar  teeth. 


- 


ORTHODONTIA. 


Fig.  385. 


-*  4 

f*^ 

f^i 

jk  V 

■      l    iff 

1^.     Mi 

Fig.  386. 


M  [SCELLANEOUS    (ASKS. 


28/ 


Fiff.  387 


JSS 


ORTHI  H  >(  i.X'llA. 


The  tightening-  of  both  arch  bars  was  then  continued 
(the  one  outside  the  arch  being  tightened  first  and  the  one  in- 
side very  carefully  so  that  most  of  the  movement  would  be 
effected  by  the  bar  on  the  outside),  until  the  incisal  edges  of 
the  upper  incisors  were  outside  the  lowers.  The  bite  bands 
were  then  removed  as  the  patient  could  get  the  teeth  together 
so  the  lowers  would  exert  pressure  against  the  lingual  surfaces 
of  the  uppers  and  assist  in  keeping  them  forward.  The  patient 
was  instructed  to  keep  the  teeth  closed  as  much  as  possible. 

Fig.  389. 


293.  At  this  stage  of  the  process  the  appliance  was  not 
tightened  for  about  three  weeks  in  order  to  give  the  alveolar 
process  an  opportunity  to  be  built  up  so  the  teeth  would  become 
somewhat  fixed  in  their  new  positions.  During  this  interval 
tin-  lower  teeth  continued  to  bite  farther  up  011  the  lingual  sur- 
of  the  uppers  until   it    was  thought    safe  to  remove  these 

appliances  and  adjust  another  to  bring  the  incisor  teeth  into 

contact,  the   interdental    spaces  being   very    wide,   as   shown   in 
Fig.  389. 


M  [SCELLANEOUS    CASES. 


289 


294.  When  the  appliances  were  removed  impressions 
were  taken  and  the  occlusion  was  then  as  shown  in  Fig.  390. 
A  studded  hand  No.  3  was  cemented  to  the  right  lateral  and  a 
single  socket  hand  Xo.  11  to  the  left  lateral.    A  stud  bar  No.  53 

Fig.  390. 


was  placed  in  position  connecting  these  teeth,  as  shown  in  Fig. 
391.  To  tighten  the  appliance  the  lock  nut  Xo.  23  is  loosened 
and   the   clutch   nut    Xo.   22   tightened,   one-half   a   revolution 

Fig.  391. 


every  other  da}-  until  the  teeth  are  in  contact,  after  which  a 
week  was  allowed  to  elapse.  At  the  end  of  this  time  a  retaining 
appliance  was  placed  in  position  as  shown  in  Fig.  393.     Xo  oth- 


290 


ORTHODONTIA. 


er  retainer  was  necessary  as  the  occlusion  of  the  teeth  prevent- 
ed the  uppers  from  moving-  back. 

295.  A  drawing  of  the  retaining  appliance  is  given  in  Fig. 
394.  It  was  necessary  to  remove  the  No.  11  band  from  the  left 
lateral  and  place  a  No.  3  in  position  so  the  retaining  and  con- 


Fig-  393- 


3* 


Fig.  394- 


.3t 


3 


nccting  band  No.  39  could  be  attached  to  the  stud.  This  re- 
tainer was  worn  for  six  months.  At  the  time  it  was  put  on  the 
occlusion  in  the  region  of  the  bicuspids  was  by  no  means  per- 
fect, as  these  teeth  were  some  distance  from  each  other.    As  the 


M  ISrKU.AXKors    CASKS. 


291 


Fig-  395- 


FiR.  396- 


20-2 


ORTHODONTIA. 


Fig.  397- 


Fig.  398. 


MISCELLANEOUS    CASES.  293 

bicuspids  will  elongate  without  assistance  no  appliance  was 
used  for  this  purpose.  At  the  time  the  retainer  was  removed 
impressions  were  taken  and  models  made,  illustrations  of  which 
appear  in  Figs.  395,  396,  and  397. 

It  will  be  seen  that  at  this  time  the  teeth  were  taking  their 
normal  positions  and  the  molars  had  not  been  forced  back 
perceptibly  during  the  operation.  Fig.  395  is  a  front  view  and 
shows  that  the  interdental  spaces  have  been  closed.  By  com- 
paring Figs.  380  and  396  it  will  be  seen  that  the  relative  posi- 
tions of  the  upper  and  lower  first  molars  have  been  changed 
very  little,  while  the  positions  of  the  upper  and  lower  incisors 
are  reversed,  and  the  bicuspids  are  in  contact.  The  change  in 
the  profile  is  seen  by  comparing  Figs.  377  and  378.  Fig.  398 
shows  a  model  of  the  upper  alone  after  the  retainer  had  been 
removed. 

Fig-  399- 


296.  Fig.  399  is  the  case  of  a  patient  twelve  years  old, 
in  which  there  were  two  perfectly  formed  lateral  teeth  on  the 
right  side  of  the  arch,  causing  the  cuspid  to  appear  through 
the  gum  some  distance  above  the  second  lateral.  As  there 
could  be  no  choice  between  the  teeth,  the  second,  or  distal,  lat- 


3)4 


ORTHODONTIA. 


eral  was  extracted.  The  remaining  lateral  and  first  bicuspid 
were  banded  with  studded  bands,  a  piece  of  retaining  and  con- 
necting band  No.  39  punched  to  fit  over  the  studs  of  the  bands, 
cut  narrower,  bent  and  placed  in  position  as  shown  in  Fig.  400. 
A  narrow  gold  band  with  a  lug  on  its  labial  surface  was  cement- 
ed to  the  tip  of  the  cuspid  and  a  rubber  ligature  attached  from 
the  lug  on  this  band  to  the  center  of  the  No.  39  as  shown.  In 
a  case  of  this  kind  a  very  weak  ligature  must  be  used  at  first, 
for  if  too  much  force  is  exerted  damage  may  result  from  the 
too  rapid  elongation  of  the  cuspid.  Two  rubbers  may  be  used, 
the  second  connecting  the  lug  of  the  cuspid  band  with  the  but- 
tons of  either  the  lateral  or  first  bicuspid  band.  The  combined 
action  of  these  two  rubbers  will  elongate  the  cuspid  and  draw 
it  into  the  arch. 

Fig.  400. 


297.  After  the  cuspid  had.  in  this  manner,  been  brought  to 
the  position  shown  in  Fig.  401,  the  connecting  band  was  re- 
versed so  that  the  central  portion  would  press  on  the  labial  sur- 
face of  the  cuspid  and  it  was  bent  in  such  a  way  that  force  was 
required  to  spring  it  down  over  the  studs,  thus  bringing  press- 
ure against  the  cuspid  to  move  it  into  the  arch.  The  action 
of  the  band  pressing  on  the  cuspid  tended  to  move  the  lateral 
out,  and  in  this  particular  case  both  cuspid  and  lateral  reached 
their  proper  positions  at  about  the  same  time.  The  connecting 
hand  was  left  in  position  for  several  months  as  a  retainer. 


M  [SCELLANEOUS    CASES. 


295 


298.  In  si  nne  cases  of  similar  nature  the  lateral  might  be 
moved  out  more  rapidly  than  the  cuspid  is  moved  in.  If  this 
should  be  the  case,  the  central,  also,  should  be  banded  and  a 
new  piece  of  retaining  and  connecting  band   (which  could  be 

Fig.  401. 


Fig.  402. 


attached  to  the  bands  on  both  central  and  lateral )  used.  This 
would  afford  ample  anchorage  to  complete  the  movement  of  the 
cuspid.     Fig.  402  shows  the  completed  case. 


296  ORTHODONTIA. 

If  a  piece  of  rather  thick  rubber  be  placed  between  the  con- 
necting band  and  the  labial  surface  of  the  cuspid,  the  action  of 
the  appliance  is  increased  and  it  is  not  necessary  to  change  the 
bend  of  the  retaining  and  connecting  band  as  often.     Fig.  403  is 


a  drawing  of  the  appliance,  showing  the  position  of  the  rubber 
between  the  tooth  and  connecting  band. 

299.     A  piece  of  retaining  and  connecting  band  cut  and 
punched  as  shown  in  Fig.  404  is  attached  by  the  nuts  Xo.  38 

Fig.  404. 


V     V 


No.  39 


to  two  bands  cemented  to  the  central  incisor  teeth.  See  Fig. 
405.  The  ends  of  the  connecting  band  rest  against  the  labial 
surfaces  of  the  laterals  and  the  spring  action  combines  to  move 


M  [SCELLANEOUS    CASES. 


297 


the  centrals  out  and  press  the  laterals  in.  The  age  of  the  pa- 
tient in  the  case  shown  was  between  seven  and  eight  years,  and 
this  will  be  found  a  good  form  of  appliance  to  use  in  cases  of 
like  character.  However,  in  cases  where  the  laterals  are  to  be 
moved  in  more  than  the  centrals  are  to  be  moved  out.  some- 
other  appliance  should  be  used,  for  with  this  appliance  the  cen- 
trals are  moved  more  than  the  laterals.  This  appliance  also 
acts  as  a  retainer  after  the  teeth  are  in  position. 

300.  A  complicated  case  is  shown  in  Fig.  406.  The  illus- 
tration shows  an  appliance  of  sufficient  complexity  to  operate 
on  all  the  teeth  at  one  time.  Generally,  it  is  well  to  divide  the 
operation  into  three  parts ;  first,  move  the  incisor  teeth  forward 
with  the  arch  bar;  second,  move  the  bicuspids  forward  through 

Fig.  405. 


the  agency  of  nuts  operating  on  the  long  screws  of  the  molar 
bands ;  third,  move  the  right  cuspid  out  into  line  with  a  jack- 
screw.  In  Fig.  407  the  detail  of  the  whole  appliance  is  shown  ; 
Fig.  408  shows  the  arch  bar  appliance  in  position,  and  Fig.  409 
is  a  detail  of  this  part  of  the  appliance.  Fig.  410  shows  the 
screw  bands  in  position  to  move  the  first  bicuspids  forward  to 
make  room  for  the  second  bicuspids. 


298  ORTHODONTIA. 

After  this  space  is  obtained  the  second  bicuspids  may  be 
drawn  into  line  by  rubber  ligatures  looped  over  the  screws  of 
the  molar  bands  and  passed  around  the  bicuspids.  Fig.  411  is 
a  drawing  of  this  part  of  the  appliance. 

The  first  two  operations  may  be  accomplished  at  the  same 
time  if  the  molars  afford  sufficient  anchorage,  as  they  do  in 
most  cases.  A  single  auxiliary  T  socket  No.  31  should,  at  the 
beginning  of  the  operation,  be  placed  on  the  arch  bar  in 
order  that  the  jack-screw  may  be  attached  whenever  required, 
without  removing  the  arch  bar.  The  nuts  at  the  distal  ends  of 
the  clutch  tubes  are  loosened  and  those  at  the  anterior  ends 
tightened  to  move  the  arch  bar  forward  and  accomplish  the 
forward  movement  of  the  incisor  teeth.  By  loosening  the 
clutch  nuts  at  the  anterior  ends  of  the  clutch  tubes  of  the  bicus- 
pid bands  and  tightening  the  lock  nuts  at  their  distal  ends,  the 
bicuspids  are  moved  forward.  Since  both  these  forces  operate 
in  the  same  direction,  the  molar  teeth  must  afford  anchorage 
for  all  the  pressure  necessary.  Whenever  this  pressure  is  too 
great  the  patient  will  complain  of  slight  soreness  of  the  molar 
teeth.  If  this  occurs  the  appliances  should  not  be  tightened  for 
four  or  five  days,  and  then  not  so  much  as  before. 

301.  The  cuspid  is  moved  into  line  with  a  jack-screw 
which  is  made  up  somewhat  differently  from  the  ordinary 
form,  the  left-hand  threaded  part  No.  40  being  used  to  engage 
the  single  auxiliary  T  socket  No.  31,  while  a  piece  of  stud  bar 
No.  53  l  <mi  which  has  been  placed  a  lock  nut)  is  used  in  the 
right-hand  cud  of  the  nul  No.  26  with  the  end  of  the  stud  bar 
bent  to  pass  over  the  stud  of  the  cuspid  band.  After  the  first 
bicuspids  have  been  moved  Forward  to  give  room  in  the  arch  for 
the  second  bicuspids,  rubber  ligatures  should  be  looped  over  the 
long  screw  of  each  molar  baud  and  passed  around  the  second 
bicuspids  to  draw  these  teeth  into  line. 


MISCELLANEOUS    (ASKS. 


299 


Fig.  406. 


Fig.  407. 


MISCELLANEOUS    CASES. 


301 


Fig.  408. 


Fig.  409. 


M  [SCELLANEOUS    CASES. 


303 


Fig-.  410. 


Fig.  411. 


Fig.  412. 


s's    -is        ito 


MISCELLANEOUS    CASES. 


305 


302.  In  the  case  shown  in  Fig.  413  the  central  incisors 
should  be  moved  forward  and  the  right  cuspid  backward,  to 
place  these  teeth  in   line.     As  the  upper  right  bicuspids  and 

molar  occluded  one  step  forward  and  the  left  occluded  normal- 
ly, the  upper  right  first  bicuspid  was  extracted  so  that  the  right 
cuspid  might  he  moved  hack  to  make  room  for  the  lateral.  As 
the  patient  was  twenty  years  old  the  molar  and  second  bicuspid 
would  not  afford  sufficient  anchorage  to  move  the  cuspid  hack, 
so  the  right  central  was  handed  with  a  No.  5  band  and  each 
molar  with  a  Xo.  50. 

Fig   4*3- 


303.  An  arch  har  was  then  placed  in  position  as  shown  in 
the  illustration.  A  single  auxiliary  T  socket  was  placed  on 
the  screw  of  the  right  molar  hand  to  afford  attachment  for  the 
jack-screw.  The  arch  har.  being  attached  to  both  molars  and 
resting  against  the  central  incisors,  greatly  reinforced  the  an- 
chorage, as  pressure  which  would  tend  to  move  the  first  molar 
forward  is  transmitted  to  the  centrals  through  the  arch  bar. 

After  turning  the  nuts  until  the  arch  bar  rested  firmly 
against  the  centrals,  they  were  tightly  locked.  A  jack-screw 
composed  of  the  same  parts  as  shown  in  Fig.  412  was  employed 
to  connect  cuspid  and  molar.     The  T  head  of  the  Xo.  40  was 


306 


ORTHODONTIA. 


placed  in  the  single  auxiliary  and  the  rounded  head  of  the  stud 
bar  No.  53  connected  to  the  stud  of  a  No.  5  band  on  the  cuspid 
by  a  stud  bar  nut  No.  54.  Detail  drawing  of  the  appliance  is 
given  in  Fig.  414. 

In  operation  the  lock  nut  No.  23  is  loosened  and  the  nut 
No.  26  turned  to  the  left :  this  draws  the  No.  53  and  No.  40  to- 
ward each  other,  retracting  the  cuspid.  This  operation  is  con- 
tinued until  the  cuspid  has  been  moved  back  sufficiently.     The 

Fig.  414. 


arch  bar  simply  reinforces  the  anchorage  during  this  part  of 
tin-  operation.  As  soon  as  the  cuspid  has  been  sufficiently  re- 
tracted, the  nuts  at  the  distal  ends  of  the  clutch  tubes  of  the 
molar  bands  are  loosened  and  those  at  the  anterior  ends  tight- 
ened, to  move  the  arch  bar  forward  and  place  the  centrals  in 
line.  A  rubber  ligature  is  looped  over  the  arch  bar  and  passed 
around  the  lateral  to  draw  it  into  the  arch. 


MISCELLANEOUS    CASES. 


307 


304.  Fig.  415  shows  an  appliance  operating  in  three  direc- 
tions, a  jack-screw  being-  employed  to  perform  one  of  the  move- 
ments. The  band  on  the  left  molar  affords  anchorage  for  the 
entire  appliance.  No.  3  studded  bands  are  cemented  to  the 
laterals  and  a  No.  13  single  socket  band  is  cemented  to  the  first 
bicuspid,  the  left  second  bicuspid  having  been  extracted.  The 
right  lateral  is  to  be  moved  out  of  inlock,  the  left  lateral  moved 
forward,  and  the  first  bicuspid  moved  back  to  make  room  for 
the  left  cuspid. 

Fig.  415. 


>  fa* 

• 

^  y\ 

T  ^ v 

^\^ 

JL    ^.  JO 

pk 

1^ 

f 

'U&^\»\ 

^ 

', 

^V^^" 

305.  A  stud  bar  No.  53  connects  the  left  lateral  with  the 
clutch  tube  of  the  molar  band.  The  rounded  head  of  the  bar 
is  held  to  the  stud  of  the  band  by  a  stud  bar  nut  No.  54.  and 
the  opposite  end  of  the  stud  bar  is  operated  by  two  clutch  nuts 
No.  22  which  engage  the  tube  of  the  molar  band.  A  single 
auxiliary  T  socket  No.  31  is  placed  on  the  stud  bar  just  anterior 
to  the  nut  No.  22,  this  forming  a  base  for  the  anchorage  of  the 
jack-screw.  The  long  screw  of  the  molar  band  passes  through 
the  clutch  tube  of  the  bicuspid  band.  A  clutch  nut  No.  22  is 
placed  on  the  screw  of  the  molar  band  and  its  rounded  portion 
enters  the  recessed  end  of  the  clutch  tube  of  the  bicuspid  band. 


308 


ORTHODONTIA. 


A  lock  nut  No.  23  serves  to  lock  the  clutch  tube  of  the  hand  to 
the  screw  of  the  molar  band  during  the  intervals  between  tight- 
ening.    Fig.  416  is  a  detail  drawing  of  this  appliance. 

To  tighten  this  appliance  the  nut  No.  22  at  the  distal  end 
of  the  clutch  tube  of  the  molar  band  is  loosened,  one  revolution 
if  the  movement  of  the  lateral  is  to  be  one  one-hundredth  of  an 
inch,  or  one-half  a  revolution  if  the  movement  is  to  be  one  two- 
hundredth  of  an  inch.  The  nut  Xo.  22  at  the  anterior  end  of  the 
clutch  tube  is  then  revolved  until  it  is  turned  tightly  into  the 

Fig-.  416. 


clutch  tube.  This  moves  the  left  lateral  forward  and  also 
moves  tbe  right  lateral  slightly,  as  the  single  auxiliary  No.  31 
which  forms  the  base  of  anchorage  for  the  jack-screw  moves 
forward  with  the  Stud  bar.     The  lock  nut  is  then  loosened  and 

the  long  nut  No.  26  turned  until  tin-  jack-screw  has  been  suf- 
ficiently tightened,  when  the  lock  nut  is  again  locked  against 
the  b;i-<-  of  the  long  nut.  Next,  the  clutch  nut  Xo.  22  .it  tbe 
distal  end  of  the  clutch  tube  <-\  the  bicuspid  band  is  loosened 


MISCELLANEOUS    CASES.  309 

and  the  lock  nut  at  the  anterior  end  tightened   until   it  firmly 
locks  the  clutch  tube,  thus  moving  the  bicuspid  back. 

306.  It  will  be  observed  that  the  force  used  to  move  the 
laterals  forward  operates  in  an  opposite  direction  from  that 
used  in  moving  the  bicuspid  back.  These  forces  arc  therefore 
equalized.  It  will  be  found  also  that  the  amount  of  force  re- 
quired to  move  both  laterals  is  about  equal  to  that  required 
to  retract  the  one  bicuspid.  It  is  always  desirable  to  relieve 
the  anchor  tooth  of  as  much  strain  as  possible,  and  this  result 
is  here  brought  about  by  the  equalization  of  the  forces. 

Fig.  417. 


As  it  takes  much  longer  to  move  the  bicuspid  back  and  the 
left  lateral  forward  to  give  room  for  the  cuspid  than  it  does  to 
move  the  right  lateral  into  line,  at  the  beginning  of  the  opera- 
tion the  appliance  may  be  placed  as  shown  in  Fig.  417.  This  is 
the  same  form  of  appliance  shown  in  Fig.  415  with  the  jack- 
screw  omitted.  As  soon  as  this  part  of  the  appliance  has  ac- 
complished about  one-half  of  the  movement  of  the  lateral  and 
bicuspid,  the  jack-screw  can  be  connected  and  the  right  lateral 
moved  into  line.  By  so  doing  the  inconvenience  caused  the 
patient  by  the  jack-screw,  which  passes  across  the  mouth,  is 
avoided  during  more  than  half  the  operation. 


310  ORTHODONTIA. 

307.  Fig.  418  shows  a  jack-screw  in  position  to  move  the 
right  lateral  and  central  forward,  to  make  room  for  the  cnspid. 
In  this  case  a  studded  band  No.  3  is  cemented  to  the  right  lat- 
eral and  a  studded  band  No.  4  to  the  left  cuspid.  A  piece  of 
connecting  band  No.  39  is  cut  and  bent  to  fit  against  the  labial 
surfaces  of  the  centrals  and  left  lateral,  and  is  attached  to  the 
stud  of  the  left  cuspid  band  by  a  retaining  clamp  nut  No.  38. 
When  the  ball  cap  No.  24  of  the  jack-screw  is  screwed  onto  the 
stud  of  the  right  lateral  band  it  holds  this  end  of  the  retaining 
and  connecting  band  in  position.     The  molar  tooth  is  banded 

Fig.  418. 


with  a  Xo.  50  band  and  a  T  socket  clutch  bar  No.  28  is  used  to 
conned  tin-  jack-screw  with  the  tube  of  the  molar  band.  The 
jack-screw  IS  expanded  to  move  the  lateral  forward.  The  con- 
necting band  which  passes  around  the  labial  surfaces  oi  the 
teeth  keep-  them  in  line  while  they  are  swung  forward  slightly, 
which  is  necessary.    The  amount  each  tooth  is  moved  decreases 

successively  from  the  righl  lateral  to  the  left  cuspid,  no  move- 
ment of  the  left  cuspid  taking  place. 

308.     The  detail  of  thi-  appliance  is  given  in  Fig.  419.    In 
this  case  the  lateral  stood  slightly  back  of  the  central,  and  it 

will   be   noticed    tliat    a    slot    is   cut    in    this   end   of   tin-    retaining 


MISCELLANEOUS    CASES. 


3" 


and  connecting  band.  The  stud  of  the  band,  at  the  beginning  of 
the  operation,  was  at  the  end  of  the  slot  nearest  the  end  of  the 
connecting  band.     This  permitted  the  lateral  to  move  until  it 


Fij 


419. 


was  in  contact  with  the  central  and  allows  the  stud  to  traverse 
the  length  of  the  slot  before  the  centrals  are  involved  in  the 
movement. 

Fig.  420. 


XT 


^3 


No  30 


Fig.  420  shows  the  retaining  and  connecting  band.  At  A 
a  hole  is  punched  for  the  stud  of  the  left  cuspid  band.  At  B  a 
succession  of  holes  is  punched,  forming  a  slot  for  the  stnd  of  the 
right  lateral  band. 


312  ORTHODONTIA. 

309.  Fig".  421  shows  an  appliance  composed  of  both  stud 
bar  and  jack-screw,  in  which  the  moving  force  is  equalized  to 
some  extent  by  the  direction  of  operation  of  the  two  appliances. 
The  second  bicuspid  and  second  molar  were  used  for  anchor- 
age in  this  case,  the  first  bicuspid  and  first  molar  having  been 
extracted  before  there  was  any  thought  of  correction.  While 
these  two  teeth  afford  enough  anchorage  to  move  the  lateral 
into  line,  thev  arc  hardly  sufficient  to  move  the  cuspid,  but,  as 
these  appliances  work  in  nearly  opposite  directions,  all  the 
force  necessarv  to  move  the  lateral  is  transferred  to  the  stud  bar 
through  the  agency  of  the  bands  on  molar  and  bicuspid  and  this 
greatly   assists    in    moving   the   cuspid. 

Fig.  421. 


A  No.  5  band  was  cemented  to  the  left  cuspid  and  a  No.  4 
to  the  right  lateral  with  their  studs  in  the  positions  shown  in 
Fig.  421.  A  single  sockel  band  No.  14  was  cemented  to  the 
s<  ond  bicuspid,  a  No.  31  placed  on  the  long  screw  of  the  molar 
band  No.  50  which  had  been  clamped  to  the  second  molar,  and 
the  end  of  the  long  screw  wired  to  the  buttons  of  the  band  on 
the  second  bicuspid.  The  T  head  of  the  jack-screw  was  placed 
in  the  No.  31  and  the  jack-screw  connected  to  the  right  lateral 

with  the  ball  cap  No.  24.      I  he  detail  of  this  is  seen  in   Fig.  422. 


M  [SCELLANEOUS    CASES. 


313 


310.     The  neck  of  the  stud  bar  is  bent  so  that  when  the 

head  is  held  to  the  stud  of  the  cuspid  band  by  the  stud  bar  nut 
No.  54  the  bar  will  rest  in  the  clutch  tubes  of  the  molar  and 
bicuspid  bands.  The  nuts  are  placed  in  position  as  seen  in  the 
illustration.  As  both  the  bicuspid  and  molar  act  as  anehorage 
they  must  not  change  their  relative  positions  during  the  op- 
eration of  the  appliance,  therefore,  when  operating  the  stud  bar 
it  is  necessary  that  both  clutch   nuts   No.  22  which  enter  the 


recessed  openings  at  the  anterior  ends  of  the  bands  on  molar 
and  bicuspid  should  be  loosened  exactly  the  same  amount,  then 
by  tightening  the  nut  Xo.  23  at  the  distal  end  of  the  clutch 
tube  of  the  bicuspid  band  and  the  nut  Xo.  22  at  the  distal  end 
oi  the  clutch  tube  of  the  molar  band  until  these  nuts  are  locked 
against  the  tubes,  the  stud  bar  is  drawn  back,  retracting  the 


314  ORTHODONTIA. 

cuspid  and  exerting  equal  force  on  both  molar  and  bicuspid. 
In  tightening  the  jack-screw,  the  lock  nut  No.  2$  is  loosened, 
the  long  nut  Xo.  25  turned  so  that  the  jack-screw  will  expand, 
and  the  lock  nut  again  locked  against  the  base  of  the  long  nut. 
The  backward  pressure  exerted  on  the  long  screw  of  the 
molar  band  is  transferred  to  the  cuspid  through  the  agency  of 
the  bands  Xo.  50  and  Xo.  14  and  the  stud  bar  No.  53. 

311.  In  the  case  shown  in  big.  423  the  upper  lip  was  de- 
ficient in  prominence,  the  four  anterior  teeth  receding  to  such 
an  extent  that  the  laterals  were  in  contact  with  the  first  bicus- 

Fig.  423. 


pids.  As  the  occlusion  of  the  bicuspids  and  molars  was  about 
normal,  and  more  prominence  of  the  lip  desirable,  the  four  in- 
cisor  teeth  were-  moved  forward  with  the  appliance  shown  in 
the  illustration.  The  laterals  were  banded  with  No.  3,  and  the 
centrals  with  No,  5  bands,  having  all  tin-  studs  projecting 
lingually.  Xo.  50  bands  were  clamped  on  the  first  molars  with 
the  clutch  tubes  lingually,  an  arch  bar  bent  to  conform  to  the 
shape  of  the  arch,  two  lock  nuts  No.  23  placed  on  the  anterior 
portion  of  the  bar  and  two  clutch  nnts  Xo.  22  placed  on  each 
end  of  the  bar  to  engage  the  clutch  tubes  of  the  bands  on  the 


MISCELLANEOUS    CASKS.  3  I  5 

molar  teeth.  The  arch  har  was  then  placed  in  position.  The 
lock  nuts  prevent  the  laterals  slipping-  hack  on  the  har  as  it 
wedges  forward. 

The  arch  har  is  moved  forward  one  one-hundred-and- 
fiftieth  of  an  inch  every  day.  The  clutch  nuts  at  the  distal 
ends  of  the  clutch  tubes  of  the  molar  bands  are  loosened  three- 
fourths  of  a  revolution  and  those  at  the  anterior  ends  tightened 
until  they  are  firmly  seated  in  the  clutch  tubes  ;  this  moves  the 
arch    bar    forward    one    one-hundred-and-fiftieth    of    an    inch. 

Fig.  424. 


i  >*^i 

^H 

^^B 

jm 

^i     M 

312.  Fig.  424  exhibits  a  similar  case  with  a  desirable  form 
of  appliance  to  use  under  certain  conditions.  In  this  case  the 
laterals  were  in  contact  with  the  bicuspids  as  in  Fig.  423.  Cen- 
trals and  laterals  were  banded  as  in  the  case  just  described,  and 
a  piece  of  retaining  and  connecting  band  was  punched  to  fit 
over  the  studs  of  the  four  bands,  bent  and  placed  in  position. 
Two  retaining  clamp  nuts  Xo.  38  were  used  to  hold  the  con- 
necting band  to  the  studs  of  the  central  bands.  The  molar 
teeth  were  fitted  with  Xo.  50  bands,  but  instead  of  the  arch  bar. 
two  stud  bars  were  used  to  connect  the  molars  with  the  four 
anterior  teeth.     Two  nuts  Xo.  22  were  arranged  on  each  stud 


3>l(T) 


l  iKTIIi  (DON  I  I  A. 


bar  to  engage  the  clutch  tubes  of  the  molar  bands,  and  the 
rounded  head  of  each  stud  bar  was  held  to  the  stud  of  the 
lateral  band  by  a  stud  bar  nut  Xo.  54.  See  Fig.  425.  In  this 
way  the  four  teeth  are  held  securely  in  their  relative  positions. 
The  appliance  is  tightened  by  operating  the  four  clutch  nuts 
which  engage  the  clutch  tubes  of  the  molar  bands.  This  forces 
the  whole  alveolar  process  forward  while  the  teeth  and  roots 
remain  in  their  same  relative  positions. 

Fie.  425. 


313.  Figure  426  shows  a  case  where  the  arch,  including 
the  laterals,  must  be  widened  to  give  room  for  the  centrals.  In 
the  treatment  of  this  case  the  upper  and  lower  arches  were  ex- 
panded, although  the  lower  i^  not  here  shown.  The  same  form 
of  appliance  seen  in  Fig.  271  was  used  to  expand  the  arch.  The 
long  screws  01  the  molar  bands  wn-c  not  cut  off  and  a^  soon  as 


M  [SCELLANEOUS    CASKS. 

Fig.  426. 


3*7 


Fig.  427. 


Fig.  428. 


318  ORTHODONTIA. 

some  room  had  been  gained  by  expansion  the  right  central  was 
banded,  a  hole  punched  in  each  end  of  a  retaining-  and  connect- 
ing band  No.  39,  and  the  ends  bent  at  right  angles.  The  long 
screws  of  the  molar  bands  were  passed  through  these  holes, 
and  the  connecting  band  held  in  place  by  screw  band  nuts.  Fig. 
427  is  a  drawing  of  the  entire  appliance.  The  connection  at  the 
ends  of  the  retaining  clamp  with  the  screws  of  the  molar  bands 
is  shown  in  detail  in  Fig.  428. 

314.  A  hole  was  punched  in  the  band  through  which  the 
stud  of  the  right  central  could  be  passed  and  a  retaining  clamp 
nut  No.  38  was  screwed  onto  the  stud  to  hold  the  connecting 
band  in  place.  By  loosening  the  nuts  A,  Fig.  428,  and  tighten- 
ing the  nuts  B,  the  connecting  band  was  drawn  back,  reducing 
the  prominence  of  the  central.  With  this  case  it  was  necessary 
to  gain  all  the  space  by  making  extra  width,  and  to  move  the 
right  central  back  as  the  lip  was  too  prominent.  The  heads  of 
the  stud  bars  No.  53  were  held  to  the  studs  of  the  lateral  bands 
by  stud  bar  nuts  No.  54. 

315.  Figure  429  shows  the  combination  of  two  appliances ; 
an  expansion  appliance  extending  from  the  first  bicuspids  to  the 
first  molars,  and  an  arch  bar  appliance  extending  from  the  mo- 
lars around  the  anterior  part  of  the  arch,  to  reduce  the  promi- 
nence of  the  centrals.  Rubbers  were  looped  over  the  arch  bar 
and  passed  around  the  laterals  to  draw  them  out  into  line,  also. 
These  appliances  can  both  be  operated  at  once, or  the  expansion 
can  l)e  partly  accomplished  before  the  arch  bar  appliance  is 
placed  in  position.  The  arch  bar  is  attached  to  the  clutch 
tubes  of  the  No.  50  bands  which  arc  used  in  the  expansion  ap- 
pliance. Fig.  430  is  a  detail  of  the  entire-  appliance,  big.  431 
shows  the  expansion  appliance  alone  in  position  on  the  model. 
Fig.  432  gives  the  numbers  and  positions  of  the  parts  employed 
in  the  expansion  appliance. 


MISCEI.I.ANKOrS    CASKS. 


319 


Fig.  429. 


Fig.  430. 


320 


ORTHODONTIA. 


316.  Fig.  433  shows  a  case  in  which  both  cuspids  were  in- 
locked  and  the  right  cuspid  was  to  be  drawn  back  a  short  dis- 
tance.   Studded  bands  No.  5  were  cemented  to  the  cuspids  with 

Fig.  43  !■ 


"~M  ">  I 

w<*. 

(Hfe 

mrZl 

"ML 

^\ 

Jmmm^    *■ 

\^     |fj..^ 

their  studs  projecting  lingually.  A  stud  bar  No.  53  was  at- 
tached from  the  right  cuspid  to  a  screw  band  on  the  right  mo- 
lar, a  single  auxiliary  T  socket  No.  31  was  placed  as  near  as 

Fig-  432- 


possible   to  the   head   of  the   Stud   liar  ;'.nd   a  jack-screw    with    a 

shorl  nnt  No.  26  connected  from  the  No.  31  to  the  stud  of  the 

hand  on  the  left  cuspid.  Fig.  434  shows  the  detail  of  this  ap- 
pliance. The  stud  bar  was  operated  to  draw  the  lefl  cuspid 
hark  bv  turning  the  nuts  No.  22  which  engage  the  tube  of  the 


MISCELLANEOUS    CASES. 


321 


molar  hand.  The  jack-screw  was  expanded  at  the  same  time 
to  force  the  cuspids  apart.  As  soon  as  the  left  cuspid  had  heen 
sufficiently  retracted  the  nuts  No.  22  were  left  locked  against 
the  tube  of  the  molar  band  and  the  action  of  the  jack-screw 
continued  until  both  cuspids  were  out  of  inlock. 

Fig.  433- 


Fig.  434- 


322  ORTHODONTIA. 

317.  Although  the  fundamental  parts  used  in  forming 
these  appliances  are  so  few  in  number  they  nearly  always  offer 
a  choice  of  combinations  for  correcting  each  individual  case, 
enabling  the  operator  to  make  use  of  parts  he  may  have  on 

Fig.  435- 


hand,  although  if  a  new  appliance  is  to  be  made  up  some  other 
form  might  be  chosen  as  simpler  and  better  adapted  to  the 
case.  The  following  serves  to  illustrate  to  some  extent  this 
variability  of  the  devices. 

Fig.  436. 


318.  Fig.  43s  is  a  case  in  which  the  central  incisors  stand 
inside  the  line  of  the  arch.  Fig.  436  shows  the  case  after  the 
incisors  have  been  moved  forward  and  the  retaining  appliance 


MISCELLANEOUS    CASKS. 


323 


removed.  No.  5  bands  were  cemented  to  the  central  incisors 
with  their  studs  on  the  labial  surfaces  of  the  teeth.  One  form  of 
appliance  which  operates  successfully  with  young  patient^  i- 
shown  in  Fig.  437.     Fig.  438  is  a  detail  of  this  appliance.     A 

Fig- 437- 


piece  of  retaining  and  connecting  band  No.  39  is  punched  to 
pass  over  the  studs  of  the  two  central  bands,  with  the  ends  pro- 
jecting over  the  labial  surfaces  of  the  laterals.  The  band  Xo. 
39  is  cut  away  Detween  the  studs  and  at  the  ends  as  shown  in 
Fig.  439,  and  is  held  to  the  studs  of  the  central  bands  by  retain- 


Fig.  439- 


TT 


TT 


No.  30 


324 


ORTHODONTIA. 


ing  clamp  nuts  Xo.  38.  The  ends  which  rest  against  the  labial 
surfaces  of  the  laterals  are  bent  so  that  when  they  are  in  con- 
tact with  these  teeth  some  pressure  is  necessary  to  spring  the 
central  portion  down  over  the  studs,  where  they  are  held  with 

Fig.  440. 


ig-44i 


the  nuts  Xo.  38.  The  spring  action  of  this  band  operates  to 
move  the  centrals  forward,  using  the  laterals  as  anchorage. 
The  pressure  of  the  appliance  is  renewed  by  removing  the  con- 
necting band  and  bending  the  ends  down  to  press  more  firmly 

againsl    the    lateral-.      In    this   manner   the   connecting   band    is 


MISCELLANEOUS    CASES.  325 

continually  straightened  as  the  centrals  move  forward.  It" 
pieces  of  rubber  one-sixteenth  inch  thick  are  wedged  under  the 

ends  of  the  connecting  band  the  movement  of  the  centrals  will 
be  continued  without  removing  the  band  as  often  as  is  other- 
wise necessary.  Fig.  440  shows  the  rubbers  in  position.  When 
the  centrals  have  moved  forward  sufficiently  the  form  of  the 
connecting  band  will  be  as  shown  in  Fig.  441.  when  it  will  act 
as  a  retainer. 

Fig.  44-7- 


319.  Fig.  442  is  the  same  case  shown  in  Fig.  435,  but  with 
an  arch  bar  accomplishing  the  movement  of  the  teeth  in  place 
of  the  connecting-  band.  The  bands  on  the  centrals  may  be 
placed  with  their  studs  pointing  either  lingually  or  labially.  If 
they  project  labially  a  piece  of  retaining  and  connecting  band 
may  be  attached  to  their  studs  for  retention,  as  shown  in  Fig. 
441,  without  removing  the  bands.  The  arch  bar  appliance  will 
move  the  teeth  at  any  age  when  movement  is  possible.  The 
arch  bar  is  anchored  to  the  molars  by  screw  bands  Xo.  50.  is 
placed  inside  the  arch,  and  the  nuts  Xo.  22  engaging  the  clutch 
tubes  of  the  screw  bands  turned  to  carry  the  arch  bar  forward. 
Both  the  arch  bar  appliance  and  the  retaining  and  connecting 


326 


ORTHODONTIA. 


band  appliance  may  be  used  at  the  same  time,  as  shown  in  Fig. 
443.    Fig.  444  shows  the  appliance  with  parts  numbered. 

Fig-  443- 


Fig.  444. 


13. 

320.  Two  stud  bars  anchored  to  screw  bands  clamped  to 
the  molar  teeth  may  also  be  used,  as  shown  in  Fig.  445.  It  is 
necessary,  when  using  this  form  of  appliance,  to  place  the  bands 
0:1   the   central    incisors    with   the  studs  pointing  lingually,  to 


MISCELLANEOUS    CASES. 


327 


permit  the  rounded  heads  of  the  stud  bars  to  pass  over  the 
studs.    The  appliance  is  operated  in  the  same  way  as  the  arch 

Fig-  445- 


Fig.  446. 


bar,  but  has  an  advantage  over  the  arch  bar  in  cases  where  one 
central  needs  to  be  moved  more  than  the  other  because  with 
the  stud  bars  the  teeth  are  moved  independently  of  each  other. 


^s 


ORTHODONTIA. 


Fig.  440  is  a  detail  of  the  stud  bar  appliance.  The  connecting 
band  cannot  be  used  with  the  bands  on  the  centrals  in  this 
position.    After  the  teeth  have  been  moved  forward  it  is  neces- 

Fig.  4-17- 


rJl+»x\ 

. 

Jwt 

J/S      «v 

m 

^    . 

Fig.  448. 


sary  to  remove  the  central  Lands  and  reverse  them  so  that  the 
studs  point  labially  in  order  that  the  retaining  hand  may  he 
applied  as  shown  in    Fig.  441. 

321.     Fig.  447  shows  two  jack-screws  operating  to  obtain 

the  same  results.     These  are  made  Up  of  the  parts  as  numbered 


MISCELLANEOUS    CASES. 


329 


in  Fig.  448.  The  bands  are  placed  on  the  centrals  with  their 
studs  pointing  lingually  and  the  jack-screws  attached  to  the 
bands  by  the  ball  caps  No.  24.  The  T  end  of  the  jack-screw 
may  be  anchored  to  the  T  socket  clutch  bar  No.  28,  which  is 
placed  in  the  clutch  tube  of  the  molar  band,  or  to  a  single 
auxiliary  T  socket  Xo.  31  placed  on  the  long  screw  of  the 
molar  band.  This  form  of  appliance  has  the  same  advantage 
as  the  stud  bar  appliance  shown  in  Fig.  445,  but  is  much  more 
complicated  and  s'hould  not  be  chosen  for  the  operation  unless 
more  convenient  for  other  reasons. 

Fig.  44Q. 


322.  Fig.  449  shows  an  appliance  consisting-  of  a  stud  bar 
and  a  jack-screw  in  position  to  move  a  lateral  and  central  forward 
and  the  cuspid  labially.  The  stud  bar  extends  from  the  right 
lateral  to  the  first  molar  and  a  single  auxiliary  No.  31  is  placed 
on  the  stud  bar  opposite  the  second  bicuspid.  Fig.  450  shows 
the  appliance  with  parts  numbered.  The  arrows  A  and  V.  in- 
dicate the  directions  of  force.  As  the  right  lateral  is  to  be 
moved  more  than  the  left  cuspid  the  appliance  is  operated 
almost  entirely  by  turning  the  nuts  No.  22  which  engage  the 
clutch  tube  of  the  molar  band.  As  the  stud  bar  moves  forward, 
indicated  at  A,  the  single  anxiliary  No.  31  will  move  with  it. 


33° 


(  IKTIIODOX'I  IA. 


This  moves  the  base  of  the  jack-screw  forward,  forcing  the 
cuspid  in  the  direction  indicated  at  B. 

Fig-  45°- 


323.  Figs.  451  and  452  show  an  appliance  composed  of  a 
stud  bar  and  two  jack-screws.  In  this  case  the  right  lateral  and 
left  cuspid  were  not  in  position.  The  right  cuspid  and  central 
were  in  contact  and  the  left  lateral  occluded  inside  the  lower 
arch.  Xo.  5  bands  were  cemented  to  the  right  cuspid  and  cen- 
tral and  a  Xo.  3  to  the  left  lateral.  A  screw  band  No.  50  was 
placed  on  the  first  molar  with  the  clutch  tube  on  the  buccal  sur- 
face of  the  tooth.  The  cuspid  was  connected  to  the  clutch  tube 
of  the  molar  band  by  the  stud  bar.  This  served  to  move  the 
CUSpid  distally  until  in  contact   with  the  first  bicuspid. 

324.  A  single  auxiliary  No.  31  was  placed  011  the  screw  of 
the  molar  band  to  afford  attachment  for  the  jack-screw  which 
extended  to  the  left  lateral.  A  lock  nul  Xo.  23  and  a  right  and 
lefl  nu1  Xo.  Jo  were  placed  on  the  long  screw  of  the  molar  band 


M  [SCELLANEOUS    CASES. 


331 


and  connected  to  the  stud  of  the  band  on  the  central  by  a  ball 
bar  No.  33  and  a  ball  cap  No.  24.  The  buttons  of  the  band  on 
the  central  were  attached  to  the  head  of  the  stud  bar  by  a 
double  strand  of  band  wire  No.  30,  as  shown  at  A,  Fig.  4^2. 

Fig:- 451. 


Fig-  452- 


When  the  stud  bar  moves  back,  as  indicated  at  B.  the  wire  A 
serves  to  hold  and  draw  back  the  distal  surface  of  the  central ; 
as  the  jack-screw    which  operates  on  the  screw  of  the  molar 


332 


ORTHODONTIA. 


band  is  expanded,  as  indicated  at  C,  the  mesial  surface  of  the 
central  is  moved  forward.  The  combined  action  of  the  wire 
A  and  the  jack-screw  accomplishes  the  rotation  of  the  central. 
As  the  stud  bar  is  contracted,  indicated  at  B,  and  the  jack-screw 
expanded,  as  indicated  at  C,  the  force  to  operate  these  two  ap- 

Fig-  453- 


pliances  is  equalized  through  the  molar  band.     By  expanding 

the  jack-screw  which  extends  to  the  left  lateral,  as  indicated  at 
I),  this  tooth  is  moved  out  of  inlock. 

Fig-  454- 


325.  An  appliance  to  move  the  lour  incisor  teeth  Forward 
to  give  room  for  the  cuspids  is  shown  in  Fig.  453.  In  this  case 
the  interdental  spaces  between  the  centrals  and  laterals  were 


MISCELLANEOUS    CASES. 


333 


wide.  Studded  hands  were  cemented  to  the  laterals  and  an  arch 
bar  appliance  placed  in  position  as  shown  in  the  illustration. 
A  lock  nut  No.  2$  was  placed  on  each  side  of  the  arch  bar  at  its 
anterior  portion  to  operate  against  the  buttons  of  the  hands  on 
the  laterals,  to  keep  the  laterals  from  slipping  hack  on  the  arch 
bar  as  the  bar  moves  forward.     A  stud  bar  nut   No.   54  was 


placed  on  the  stud  of  each  lateral  band.  Two  rubber  ligatures 
were  connected  and  passed  around  the  anterior  part  of  the 
centrals  as  shown  in  Fig.  454.  Fig.  455  is  an  enlarged  drawing 
of  the  appliance  with  parts  numbered  and  shows  the  rubber 
ligatures  in  position. 


334 


ORTHODONTIA. 


These  rubbers  should  be  renewed  twice  a  week  and  serve 
to  draw  the  centrals  and  laterals  toward  each  other  until  in 
contact.  As  soon  as  this  is  accomplished  the  rubbers  are  re- 
moved and  either  a  piece  of  retaining  and  connecting'  band 
placed  over  the  studs  to  hold  the  teeth  together,  or  the  stud 
bar  nuts  may  be  wired  together  with  band  wire  No.  30. 

326.  Fig.  456  shows  a  case  where  the  central  had  erupted 
inside  the  line  of  the  arch.  The  patient  was  six  years  old.  A 
studded  band  was  cemented  to  the  central,  a  piece  of  retaining 

Fig.  456. 


and  connecting  band  punched  to  fit  over  the  stud  of  the  band 
and  cut  narrower  at  each  end.  One  end  projected  over  the  left 
central  and  the  other  over  the  temporary  right  cuspid  as  the 
right  lateral  was  not  yet  in  position.     It  was  necessary  to  cut* 

Fig-  457- 


this  pari  from  a  No.  39  as  the  end  of  a  retaining  clamp  No.  37 
would  not  1m-  Long  enough  to  reach  to  the  cuspid.  The  appli- 
ance operated  by  spring  action  and  was  composed  of  the  parts 
sh<  mil  in  Fig.  457. 

327.  Fig.  458  •-hows  an  appliance  which  operates  by  spring 
action  in  position  to  expand  the  lower  arch.  Studded  bands 
were  cemented  to  the  cuspids  with  the  studs  projecting  lingual- 

]v  and  studded   screw    hands   were  placed  on   the  second   bicus 


MISCELLANEOUS    CASES. 


335 


pids.  Pieces  of  No.  39  were  punched  to  pass  over  the  studs 
of  the  cuspid  and  bicuspid  band  of  each  side  and  bent  to  rest 
against  the  teeth.     The  distal  ends  rested  against  the  molars. 

Fig.  458. 


Retaining  clamp  nuts  No.  38,  shown  at  EE,  Fig.  459,  held  the 
connecting  bands  to  the  studs  of  the  bicuspid  bands.  The  re- 
taining and  connecting  bands  C   and   D  were  punched  about 

Fig-  459- 


midway  between  E  and  F  for  the  recepticn  of  the  ends  of  the 
spring  wire  A.  This  spring  is  made  of  18  gauge  rideo  platinum 
wire  and  bent  at  each  end  to  pass  through  the  holes  in  the  con- 
necting bands.    The  direction  of  force  is  indicated  at  B. 

An  appliance  of  this  form  offers  very  little  inconvenience 


3& 


ORTHODONTIA. 


to  the  patient  and  is  practical  in  most  cases,  although  some- 
times it  is  impossible  to  get  the  wire  to  exert  sufficient  force 
and  it  is  then  necessary  to  resort  to  the  jack-screw.  The  spring 
wire  A  may  be  placed  in  the  position  shown  in  Fig.  458,  or  may 
be  thrown  forward  so  it  lies  against  the  lingual  surfaces  of 
the  incisor  teeth,  as  shown  in  Fig.  460.  In  forming  the  spring- 
it  is  necessary  that  the  curve  be  not  too  long,  as  this  would  pre- 
vent it  being  placed  in  the  position  shown  in  Fig.  460. 

Fig.  400. 


328.  Fig.  461  shows  a  stud  bar  appliance  in  position  to 
draw  the  first  bicuspid  back  after  the  second  has  been  extract- 
ed, to  give  room  for  the  cuspid,  and  a  double  jack-screw  ap- 
pliance in  position  to  move  the  cuspid  into  the  arch  and  force 
the  lateral  out  into  line.  In  this  case  the  second  bicuspid  was 
extracted  on  account  of  being  badly  decayed.  If  this  had  not" 
been  the  case  the  first  bicuspid  should  have  been  removed  and 
thus  save  mining  it  back  into  the  position  ol  the  second.  The 
anchorage  for  the  stud  bar  appliance  was  obtained  from  the 
second  molar  as  the  first  molar  would  not  .afford  sufficient  re- 
sistance to  move  the  bicuspid.  Fig.  402  gives  the  detail  of  the 
stud  bar  appliance  with  parts  numbered. 


MISCELLANEOUS    CASES. 


337 


329.      Both  molars  may  be  firmly  locked  together  and  thus 

afford  greater  anchorage  resistance,  if  the  first  molar  is  banded 

with  a  double  socket  button  band  and  the  screw  of  the  band  on 

the  second  molar  locked  firmly  in  the  clutch  tube  of  this  band 

with  clutch  nuts  No.  22.     The  detail  of  such  a  combination  is 

shown  in  Fig.  463. 

Fig.  461. 


Fig.  464  gives  the  detail  of  the   double  jack-screw  with 
parts  numbered.    In  this  case  it  was  necessary  to  move  the  lat- 


3& 


ORTHODONTIA. 


eral  only  a  short  distance,  while  the  cuspid  must  move  much 
farther.  A  screw  band  was  placed  on  the  right  molar  for  an- 
chorage. The  jack-screw  attached  to  the  cuspid  was  contract- 
ed, moving  in  the  direction  indicated  by  the  arrow  A,  and  the 
jack-screw  which  connected  to  the  lateral  expanded,  as  indicat- 
ed by  the  arrow  B.  These  forces  oppose  each  other  and  are 
equalized  through  the  No.  31  on  the  base  of  the  jack-screw  ex- 
tending to  the  cuspid.  This  relieves  the  anchor  tooth  of  all 
strain. 

Fig.  463. 


330.  As  soon  as  the  lateral  had  been  moved  into  line  this 
jack-screw  was  left  locked  and  the  operation  of  the  jack-screw 
extending  to  the  cuspid  continued.  As  the  cuspid  over-lapped 
the  lateral  to  some  extent  it  came  in  contact  with  the  disto- 
labial  angle  of  the  lateral.  The  tendency  would,  therefore, 
be  to  move  the  lateral  linguallv,  but  as  it  was  held  firmly 
in  position  by  the  second  jack-screw  the  cuspid  was  crowded 
distally  as  Easl  as  the  bicuspid  was  retracted  i"  make  room  for 
it. 


MISCELLANEOUS    CASES. 


339 


331.  When  the  cuspid  was  in  line  all  parts  of  both  ap- 
pliances, except  the  band  on  the  cuspid,  were  removed  and  a  re- 
taining clamp  was  attached  to  the  stud  of  the  cuspid  band  by  a 
retaining  clamp  nut  No.  38,  to  retain  all  three  teeth.  The  an- 
terior end  of  the  retaining  clamp,  which  rested  on  the  lingual 
surface  of  the  lateral,  prevented  this  tooth  moving  lingually, 

Fig.  464. 


Fig.  465. 


and  as  the  clamp  extended  over  the  lingual  surfaces  of  both 
lateral  and  first  bicuspid  it  prevented  the  cuspid  moving  labi- 
ally.  In  this  way  all  three  teeth  are  retained  while  only  one  is 
banded.     See  Fig.  465. 


34Q 


ORTHODONTIA. 


332.  In  the  case  illustrated  in  Fig.  466  it  was  necessary  to 
move  the  first  bicuspid  and  cuspid  back  so  the  incisor  teeth, 
which  over-lapped  each  other,  might  be  placed  in  proper  line. 

Fig.  466. 


Fig.  467. 


As  it  was  necessary  t<>  gain  as  much  anchorage  as  possible  to 
move  the  first  bicuspid  back,  the  firsl  molar  was  banded  with 
a  double  socket  screw  hand,  the  long  screw  of  which  passes 


MISCELLANEOUS    CASKS. 


341 


through  the  clutch  tube  of  a  single  socket  button  band  cement- 
ed to  the  first  bicuspid.  A  studded  band  is  placed  on  the  cuspid 
and  connected  to  the  clutch  tube  of  the  molar  band  by  a  stud 
bar  appliance.  This  reinforces  the  anchorage  while  the  bicus- 
pid is  being  moved  by  turning  the  nuts  which  engage  the  clutch 
tube  of  the  band  on  that  tooth.  A  detail  of  the  appliances  with 
parts  numbered  is  given  in  Fig.  467.  As  soon  as  the  bicuspid 
is  in  position  the  band  is  removed  from  the  first  molar  and 
placed  on  the  second  molar.  The  screw  of  the  molar  band  is 
locked  to  the  clutch  tube  of  the  band  on  first  bicuspid,  which 
holds  all  three  teeth  firmly  in  relation  to  each  other.  The  cus- 
pid is  then  drawn  back  with  the  stud  bar. 

Fig.  468. 


333-  Fig.  468  shows  a  case  where  two  stud  bar  appliances 
are  employed  to  move  the  laterals  forward  to  give  room  for  the 
cuspids.  One  of  the  stud  bars  is  placed  on  the  lingual  side  of 
the  arch  and  the  other  on  the  buccal  side.  It  is  immaterial  as 
to  which  side  of  the  arch  either  stud  bar  is  placed.  They  should 
be  placed  on  the  side  which,  from  the  position  of  the  teeth,  is 
most  convenient.     In   this   case  the   lateral  on  the  right  side 


34-' 


ORTHODONTIA. 


stood  too  far  to  the  lingual  and  the  cuspid  was  in  such  a  po- 
sition as  to  interfere  with  the  operation  of  the  stud  bar  if 
placed  on  the  buccal  side  of  the  arch.  The  necks  of  the  stud 
bars  are  bent  so  the  rounded  heads  pass  over  the  studs  and  lay 
flat  against  their  bases.  Fig.  469  is  a  drawing  of  the  parts, 
numbered,  and  shows  the  bend  in  the  necks  of  the  stud  bars. 

Fig.  469. 


334.  Fig.  470  shows  a  jack-screw  in  position  to  move  a 
cuspid  out  of  inlock.  In  this  case  a  single  socket  band  was 
cemented  to  the  right  first  bicuspid,  a  No.  31,  Xo.  23  and  No.  22 
placed  on  the  long  screw  of  the  molar  band  and  the  molar  band 
clamped  to  the  right  first  molar.  The  screw  of  the  molar  band 
passes  through  the  clutch  tube  of  the  bicuspid  band  and  is  firm- 
ly locked  in  the  tube-  with  the  nuts  Xo.  22  and  No.  2$.  In  this 
case  the  jack-screw  is  made  up  with  tlu-  shorl  right  and  left 


MISCELLANEOUS    (ASMS. 


343 


nut  No.  26  as  the  distance  from  the  screw  of  the  molar  band  to 
the  cuspid  is  too  short  for  the  employment  of  the  Xo.  25.     Fig. 

471  gives  the  detail  of  the  appliance  with  parts  numbered.     Fig. 

472  shows  the  retainer  in  position  to  hold  the  cuspid  after  it  has 
been  moved  into  line. 

Fig.  470. 


Fig- 4/~i- 


344 


ORTHODONTIA. 


335-  Fig-  473  shows  a  case  where  the  four  upper  incisor 
teeth  occlude  on  the  lingual  surfaces  of  the  lowers.  The  center 
line  of  the  uppers  was  half  the  width  of  a  central  incisor  to  the 
right  of  the  center  of  the  face,  while  the  center  line  of  the  lowers 

Fig.  472. 


Fig-  473- 


was  normal.  The  u  >per  right  lateral  was  in  contact  with  the 
right  first  bicuspid.  The  cuspid  was  erupting  outside  the  line 
of  the  arch  high  up  in  the  gum,  as  seen  in  the  illustration.    The 

prominence  of  the  lower  lip  was  normal,  while  the  Upper  lip 
was   receding.      'I  In-   upper   model    alone    is   shown    in    Fig.  474. 

''  he  upper  lefl  firsl  molar  was  badly  decayed  and  abscessing,  so 
that  it  was  necessary  to  extract  it. 


MlSCKLLANKOl'S     (ASICS. 


345 


336.  To  place  the  teeth  in  their  proper  positions  it  was 
necessary  to  move  the  four  incisor  teeth  forward  and  to  the  left 
until  they  occluded  anterior  to  the  lowers  and  there  was  room 

Fig.  474. 


M 

W  1 

W 

^ — i 

: — 11 

Fig-  475- 


between  the  lateral  and  first  bicuspid  for  the  right  cuspid.  An 
appliance,  a  drawing  of  which  is  shown  in  Fig.  47s<  wjn  operate 
successfully  on  such  a  case. 


346  ORTHODONTIA. 

A  studded  band  No.  3  is  cemented  to  the  right  lateral  and 
a  No.  5  to  the  left  cuspid.  A  piece  of  retaining  and  connecting 
band  Xo.  39  is  punched  to  pass  over  their  studs  and  cut  and 
bent  to  rest  against  the  lingual  surfaces  of  the  intervening 
teeth.  This  serves  to  hold  the  incisor  teeth  in  line  while  being 
moved.  A  screw  band  No.  50  should  be  placed  on  the  right  mo- 
lar with  the  screw  on  the  lingual  surface  of  the  arch,  project- 
Fig.  476. 


ing  anteriorly.  A  lock  nut  Xo.  23  is  placed  on  the  long  screw 
to  operate  against  the  base  of  the  nut  No.  26  and  a  ball  bar  and 
ball  cap  connect  the  nut  Xo.  26  with  the  stud  of  the  band  on  the 
lateral.  When  the  ball  cap  is  screwed  onto  this  stud  it  holds 
the  retaining  and  connecting  band  firmly  in  position  and  also 
permits  free  movement  of  the  ball  in  the  ball  cap. 

The  left  cuspid  is  connected  to  the  second  molar  by  a  stud 
bar  appliance.  As  the  left  second  molar  is  smaller  than  the 
right  it  i1-  necessary  to  use  a  Xo.  49  screw  band  on  this  tooth. 
In  operation,  tin-  nut  No.  26  of  the  jack-screw  should  be  turned 
so  the  jack-screw  will  expand.  This  moves  the  teeth  forward 
and  the  nuts  which  are  On  the  stud  bar,  engaging  the  clutch 
tube  of  the  band  on  left  second  molar,  should  be  operated  so  the 
stud    bar   moves   distally.     The   tendency   of  these   combined 


MISCELLANEOUS    CASKS.  347 

movements  is  to  move  the  incisor  teeth  forward  and  to  the  left. 
In  this  case  the  operation  was  continued  until  the  left  second 
molar  was  in  contact  with  the  left  second  bicuspid,  the  upper 
incisor  teeth  occluded  anterior  to  the  lowers  and  there  was* 
nearly  room  enough  in  the  arch  for  the  cuspid.  During  this 
part  of  the  operation  the  left  bicuspids  and  cuspid  had  been 
moved  back  to  some  extent  and  the  second  molar  had  moved 
forward. 

Fig-  477- 


337.  As  there  was  no  advantage  in  moving  the  left  cuspid 
and  bicuspids  back  farther  the  appliance  was  removed  and  a 
triple  jack-screw  used  as  shown  in  Fig.  476.  Fig.  477  is  a 
drawing  of  the  appliance  with  the  parts  numbered. 

As  the  right  lateral  needed  to  be  forced  labially  about  one- 
sixteenth  of  an  inch,  the  anterior  jack-screw  was  operated  until 
this  tooth  was  in  line.  The  central  jack-screw  was  contracted 
to  draw  the  cuspid  into  line  and  the  posterior  jack-screw  was 
left  locked  to  hold  the  bicuspid  rigidly  in  position.  As  there 
was  yet  insufficient  room  for  the  cuspid  between  the  lateral  and 
first  bicuspid  it  was  necessarv  to  force  these  teeth  apart.  The 
triple  jack-screw  accomplishes  this  by  crowding  the  cuspid  in 


348 


ORTHODONTIA. 


between  the  two  teeth,  holding  the  lateral  and  bicuspid  in  line 
while  this  is  being  done. 

The  force  used  in  drawing  the  cuspid  in  is  transmitted  to 
the  lateral  and  bicuspid  through  the  double  auxiliary  Xo.  32 

Fig.  478. 


Fig.  479- 


which  connects  the  anterior  and  posterior  jack-screws  to  the 
central  jack-screw.  This  relieves  the  anchor  tooth  of  all  strain. 
the  lateral  and  bicuspid  affording  tin-  anchorage  for  moving 
the  cuspid  into  the  arch. 

338.  Fig.  478  shows  the  positions  of  the  teeth  after  the 
cuspid  is  in  line.  It  will  be  noticed  that  the  left  second  molar  is 
in   contact   with    the   second   bicuspid,   the   space    former! \    oc- 


MISCELLANEOUS    CASES. 


349 


cupied  by  the  left  first  molar  having  been  closed  entirely.  Fig. 
479  shows  the  occlusion  of  the  teeth  after  the  case  is  com- 
pleted. By  comparing  Fig.  479  and  Fig.  473  the  change  in  the 
center  line  will  be  noted.  It  should  also  be  observed  that  in 
Fig.  479  the  teeth  stand  in  their  proper  positions  and  are  not 
tipped  to  the  left,  as  some  might  think  they  would  be  when 
moved  laterally  through  the  process. 

Fig.  480. 


339.  The  case  of  a  patient  thirteen  years  old  is  shown  in 
Fig.  480.  The  upper  arch  was  narrow  and  the  upper  lip  rather 
prominent.  The  permanent  first  bicuspids  were  inlocked  and 
one  step  forward.  Fig.  481  shows  the  upper  model.  As  no 
more  prominence  of  the  upper  incisor  teeth  is  permissible  the 
upper  right  and  left  first  bicuspids  were  extracted,  as  seen  in 
Fig.  482.  Studded  bands  were  cemented  to  the  laterals  and  an 
arch  bar  appliance  placed  in  position  as  shown  in  Fig.  483. 
When  the  arch  bar  rests  against  the  laterals  between  the 
studs  of  the  bands  and  the  gum  and  is  locked  in  the  clutch 
tubes  of  the  molar  bands  by  clutch  nuts  Xo.  22,  the  greatest 
possible  amount  of  anchorage  is  obtained  to  offer  resistance  for 


350 


ORTHODONTIA. 


moving  the  cuspids.  The  force  necessary  to  move  the  cuspids 
lingually  is  equalized  through  the  arch  bar,  as  the  cuspids 
move  in  opposite  directions.  Thus  the  teeth  to  which  the  arch 
bar  is  anchored  need  offer  only  sufficient  resistance  to  move 
the  cuspids  distally. 

Fig.  481. 


■  ■  ^ 

Bfr 

^l5v; 

Br  * 

i 

^B 

Ft 

\  1 

L_^ 

^^^mm 

^^^^^^ 

Fig.  482. 


Fig.  484  gives  the  detail  of  the  appliance  with  parts  num- 
bered. A  narrow  gold  band  with  a  lug  on  its  labial  surface  was 
cemented  to  each  cuspid  and  a  rubber  ligature  looped  over  the 
arch  bar  at  a  position  between  lateral  and  temporary  second  mo- 


MISCELLANEOUS    CASES. 


351 


Fig.  483. 


Fig.  484. 


RUBBER  LIGATURE  I 


RUBBER  LIGATURE 


352  ORTHODONTIA. 

lar  and  passed  around  the  cuspid  above  the  lug  on  the  band,  as 
shown  at  A.  This  draws  the  cuspids  diagonally  backward  and 
into  the  arch.  Another  rubber  may  be  passed  over  the  distal 
end  of  the  arch  bar  and  attached  to  the  cuspid  by  a  silk  liga- 
ture when  necessary  to  draw  the  cuspid  directly  back.  This  is 
not  shown  in  the  illustration.  Studded  bands  may  be  used  on 
the  cuspids  when  these  teeth  are  sufficiently  erupted.  On  the 
right  side  a  studded  band  Xo.  4  is  shown  with  the  rubber  liga- 

Fig.  485. 


ture  looped  over  the  arch  bar  and  passed  around  above  the  but- 
tons of  the  band.  The  buttons  serve  the  same  purpose  as  the 
lug  of  the  gold  band  shown  at  A.  They  simply  prevent  the 
rubber  slipping  off  the  tooth.  These  rubbers  should  be  re- 
newed at  least  twice  a  week  until  the  cuspids  are  in  contact 
with  the  arch  bar.  Fig.  485  shows  the  case  at  this  stage  of  the 
o], (-ration. 

340.  When  employing  rubber  ligatures  for  moving  cus- 
pids, tiny  must  never  be  attached  to  simply  molar  anchorage, 
for  the  molar-  will  be  moved  forward  in  nearly  every  case; 
while  if  extended  anchorage  i1-  \]^^'\  this  danger  is  avoided. 


MISCELLANEOUS    CASES. 


353 


Fig.  486. 


Fig.  487. 


354 


ORTHODONTIA. 


341.  The  lower  left  lateral  was  inside  the  line  of  arch.  A 
Studded  band  No.  2  was  cemented  to  this  tooth  with  the  stud 
projecting  labially  and  a  retaining  clamp  Xo.  37  used  to  draw 
the  tooth  into  line,  as  shown  in  Fig.  486.  This  appliance  was 
operated  simultaneously  with  the  upper.  The  retaining-  clamp 
is  removed  twice  a  week  and  the  ends  bent  down  to  increase  the 
pressure.  When  the  lateral  is  in  line  the  clamp  is  left  in  po- 
sition to  retain  the  tooth. 

Fig.  488. 


Fig.  4S7  shows  the  lower  arch  with  the  lateral  in  line.  In 
a  case  like  this  where  there  is  insufficient  room  in  the  arch  for 
the  lateral,  the  first  part  of  the  operation  is  much  slower  than 
the  lasl  for  it  is  necessary  for  the  retaining  clamp,  in  moving 
the  tooth  forward,  to  increase  the  space  between  the  central  and 
CUSpid  in  order  to  admit  tile  lateral.  Fig.  488  shows  the  occlu- 
sion of  the  teeth  after  the  operation  had  been  completed. 

342.  The  case  of  a  patienl  eleven  years  old,  where  the  up- 
per jaw  protruded  to  such  an  extent  that  it  was  impossible  for 
the  patient  to  rover  the  upper  teeth  with  the  upper  lip,  is  shown 
in  Fig.  4^'j-     Fig.  490  i1--  a  photograph  of  the  patient  at  the  com- 


M  I  SCELLANEOUS    CASKS. 


355 


mencement  of  the  operation.  The  upper  right  and  left  first 
bicuspid  was  extracted  and  the  regular  protrusion  appliance 
used,  drawing  of  which  is  given  in  Fig.  491.  Gold  hands  were 
made  for  the  centrals  with  a  nick  in  the  labial  surface  of  each 
-where  the  hand  is  soldered  tog-ether,  for  the  reception  of  the 
arch  bar.  as  shown  in  Fig.  492.  The  head  cap  and  protrusion 
bow  were  worn  at  night  for  nine  months,  at  the  end  of  which 
time  the  prominence  of  the  upper  jaw  had  been  reduced  to  the 


Fig.  489. 


extent  shown  in  Fig.  493.  Fig.  494  shows  the  permanent  im- 
provement in  the  facial  lines,  as  this  photograph  was  taken 
nearly  two  years  after  the  retaining  appliance  was  removed. 

When  the  prominence  of  the  upper  jaw  is  very  extensive  and 
a  line  drawn  between  the  central  incisors  is  exactly  in  the  cen- 
ter of  the  face,  it  is  important  that  both  sides  of  the  arch  should 
move  equally,  therefore  the  head  cap  should  be  placed  in  posi- 
tion so  the  lower  buttons  are  equally  distant  from  the  center 
■of  the  back  of  the  head,  as  shown  in  Fig.  495. 


356 


ORTHODONTIA. 


Fig.  490. 


MISCELLANEOUS    CASKS. 


357 


Fig-491 


CHUCk 


Fig.  4(P- 


L 


358 


ORTHODONTIA. 

Fig-  493- 


Fig.  494. 


MISCELL  Wl'.nrs     (ASKS. 


359 


Fig-  495- 


MISCELLANEOUS    CASES. 


361 


343.  Fig.  496  shows  the  occlusion  of  the  teeth  of  a  patient 
twenty  years  of  age.  The  bicuspids  of  either  side  occluded 
normally,  but  the  upper  incisor  teeth  were  not  of  sufficient 
prominence;  the  right  cuspids,  upper  and  lower,  being  crowded 

Fig.  496. 


Fig.  497. 


out  of  the  arch.  The  upper  right  lateral  occluded  on  the  lin- 
gual surface  of  the  lower  cuspid.  More  prominence  of  the  up- 
per lip  was  desirable.  See  Fig-.  498.  In  this  case  an  appliance 
as  shown  in  Fig'.  500  was  used. 


362  ORTHODONTIA. 

344.  Studded  bands  were  cemented  to  the  laterals  with 
the  studs  projecting  labially  and  an  arch  bar  placed  inside  the 
arch,  passing  through  the  clutch  tubes  of  the  bands  on  the  mol- 
ar teeth,  as  shown  in  the  illustration.  Two  holes  were  punched 
in  a  retaining  and  connecting  band  to  pass  over  the  studs  of 
the  laterals.  The  central  portion  and  ends  of  the  connecting 
band  were  cut  narrower  as  shown  in  Fig.  501.  This  was  held 
to  the  studs  of  the  bands  by  retaining  clamp  nuts  No.  38.  The 
arch  bar  was  bent  to  press  against  the  right  lateral  band  firmly 
between  the  buttons  of  the  band  and  the  gum.  This  was  the 
only  point  where  the  arch  bar  was  in  contact  with  the  incisor 
teeth,  all  the  pressure  being  exerted  against  the  right  lateral. 
This  would  cause  the  right  lateral  to  be  moved  first,  then  as  the 
bar  moves  forward  it  would  come  in  contact  with  the  right  cen- 
tral, and  next  with  the  left  central. 

The  right  lateral  and  both  centrals  were  nearly  in  line  at 
the  time  the  arch  bar  came  in  contact  with  the  left  lateral,  so 
that  the  left  lateral  was  moved  but  very  little.  Fig.  502  is  the 
detail  drawing  of  the  whole  appliance. 

The  connecting  band  was  removed  twice  a  week  and  the 
end  which  projected  over  the  right  cuspid  bent  down  to  in- 
crease the  pressure.  Also,  a  piece  of  rubber  one-sixteenth  of 
an  inch  thick  was  placed  between  the  labial  surface  of  the  right 
cuspid  and  the  connecting  band  to  increase  the  pressure.  The 
combined  action  of  the  two  appliances  moved  the  four  anterior 
teeth  forward  until  they  were  in  line  as  shown  in  Fig.  497. 
A  iter  they  were  in  line  they  were  retained  by  a  piece  of  retain- 
ing and  connecting  band  No.  39  placed  Oil  the  lingual  surfaces 
of  the  anterior  teeth.  Studded  bands  were  cemented  to  the 
cuspids  and  righl  central,  with  the  studs  projecting  lingually. 
The  retaining  and  connecting  band  was  punched  to  pass  over 


M  ISCELLANEOUS    CASES. 


363 


Fig.  498. 


Fig.  499. 


364 


ORTHODONTIA. 
Fig.  s°o. 


Fig.  501 


\F  \f 


No  jo 


M  [SCELLANEOUS    CASES. 


365 


the  studs  and  overlapped  the  bicuspid  teeth,  in  the  same-  man- 


ner as  sin  iwn  m  r  n 


345.     Fig.  503  shows  the  lower  arch  with  appliance  in  po- 
sition to  move  the  incisor  teeth  forward.     Studded  hands  were 

Fig.  503. 


Fig.  504. 


cemented  to  the  left  cuspid  and  right  lateral  with  the  studs  Ini- 
tially, and  connected  by  a  connecting  hand  No.  39.  The  end 
of  the  connecting  hand  on  the  right  side  was  bent  and  cut  nar- 


366 


ORTHODONTIA. 


rower  to  pass  through  the  head  of  a  stud  bar.  The  right  first 
molar  was  banded  and  a  stud  bar  connected  as  shown  in  the 
illustration.  The  nuts  on  the  stud  bar,  which  engage  the  clutch 
tube  of  the  molar  band,  were  operated  so  the  stud  bar  moved 
forward.  This  moved  the  connecting  band  and  the  four  teeth, 
swinging  the  right  side  forward,  with  very  little  movement 
on    the    left    side.      Fig.    504    is   a    drawing   of   the    appliance. 

Fie.  ^o;. 


Fig.  506. 


346.  As  soon  as  the  teeth  were  in  line  all  parts  were  re- 
moved except  the  band  on  the  left  cuspid.    A  studded  band  was 

nted  to  the  right  cuspid  and  a  connecting  band  attached 
to  the  stu,].  of  the  bands,  resting  against  the  lingual  surfaces 


MISCELLANEOUS    CASES. 


367 


of  the  incisor  teeth.  This  served  to  hold  the  teeth  in  line  and 
was  worn  for  six  months.  Fig.  408  shows  the  facial  lines  he- 
Fore  the  operation,  and  Fig.  400  shows  the  prominence  of  the 
lips  after  the  teeth  had  been  moved  forward.  In  Fig.  498  it  will 
he  noticed  that  the  lips  are  too  straight,  giving  a  flat  appear- 
ance to  the  month,  while  in  Fig.  400  the  lips  have  the  proper 
fullness,  the  upper  lip  curving  slightly  forward. 

Fig.  507. 


Fig.  508. 


347.  The  case  shown  in  Fig.  505  would  seem  to  he  simple  a 
case  of  protrnsion  of  the  upper  arch,  but  by  taking  into  consid- 
eration the  facial  lines   (see  Fig.  506).  the  profile  shows  that 


3<  i8 


OKTHODO.N ITIA. 


the  tipper  lip  is  not  unduly  prominent,  hi  fact,  more  promi- 
nence would  improve  the  appearance,  and  the  lower  lip  and 
chin  recede  to  quite  an  extent.  To  correct  the  condition  the 
lower  jaw  should  be  moved  forward  until  the  teeth  occlude  as 
shown  in  Fig.  507.  To  accomplish  this  it  is  necessary  to  con- 
Fig-  5°{)- 


Fig.  510. 


M  ISCELLANEOUS     (ASMS. 


369 


struct  an  appliance  which  will  move  the  lower  jaw  forward,  and 
the  resistance  necessary  must  be  gained  from  the  upper. 

Fig.    508   shows   the   improvement   in    the   facial   lines   after 
the  lower  jaw  has  been  moved  forward. 

Fig.  511. 


Fisr.  ^12. 


Fig.  509  shows  an  appliance  on  the  upper  arch  which  affords 
sufficient  anchorage  to  move  the  lower  jaw  forward.  In  this 
case  single  socket  bands  No.  13  were  cemented  to  the  central 


3/0 


ORTHODONTIA. 


incisors  with  their  clutch  tubes  on  the  labial  surfaces  of  the 
teeth.  Screw  bands  Xo.  50  were  placed  on  the  molars  and  an 
arch  bar  with  a  bar  hook  Xo.  55  on  each  side  placed  in  position 
as  shown  in  Fig".  510.    When  the  nuts  No.  22  are  locked  in  the 

Fig.  $*$. 


Fig.  514- 


tubes  of  the  molar  bands  the  whole  upper  arch  acts  as  anchor- 
offering  sufficient  resistance  to  move  the  lower  jaw  for- 
ward when  attachment  is  made  to  the  bar  hook  on  cadi  side. 

Fig.  511   shows  the  appliance  on  the  lower  arch.     Fig.  512 
gives  the  detail.     In  this  case  the  studded  hands  are  placed  on 


M  [SCELLANEOUS    CASES. 


3/i 


the  laterals  with  the  studs  lingually,  and  double  socket  screw 

bands  placed  on  the  molars  with  the  clutch  tubes  on  the  lingual 
surfaces  of  the  teeth.  A  bar  hook  No.  55  is  placed  on  the 
screw  of  each  molar  band  in  the  position  shown  in  the  illustra- 

Fig-  5*5- 


Fig.  516. 


tion.  An  arch  bar  is  used  on  the  inside  of  the  lower  arch  so 
that  all  the  teeth  anterior  to.  ami  including,  the  first  molars 
may  act  as  anchorage. 

When  an  arch  bar  is  so  placed  and  forward  pressure  exerted 
on  the  bar  hooks,  the  entire  lower  arch  otters  resistance,  other- 
wise the  molars  would  be  displaced.  The  upper  and  lower 
bar  hook  of  each   side  are   connected  by  rubber  ligatures  as 


372 


ORTHODONTIA. 


shown  in  Fig.  513.  The  action  of  these  ligatures  will  move  the 
lower  jaw  forward,  and  they  must  be  worn  until  a  new  articu- 
lation is  formed  at  the  glenoid  fossa.  The  condyle  of  the  lower 
jaw  is  drawn  forward  under  the  articular  eminence. 

Fig.  517. 


Fig.  518. 


Fig.  514  shows  the  casts  with  the  rubbers  in  position  while 
the  teeth  occlude  as  shown  in  Fig.  505.  Fig.  515  shows  the 
lower  jaw  drawn  forward  by  the  action  of  the  rubbers.  After 
the  rubbers  have  been  worn  for  some  time  so  that  the  patient 
becomes  accustomed  to  holding  the  jaw  forward,  the  rubbers 
should  be  removed  and  a  wire  connection  substituted.  Fig. 
516  shows  this  connection.  The  jaws  arc  placed  in  their  prop- 
er positions  and    five  or   six   loops  of  the  band   wire   wound 


MISCELLANEOUS    CASES. 


373 


around  the  hooks  in  the  same  manner  that  the  buttons  of  a  but- 
ton band  arc  wired  together,  ddiis  holds  the  jaws  rigidly  in 
their  relative  positions  and  permits  mastication,  as  it  forms 
a  swivel  connection.  The  jaws  are  perfectly  free  to  move  lat- 
erally ;  but  to  open  or  close,  the  lower  jaw  must  move  forward 
more  than  it  would  ordinarily,  The  connection  of  the  wire 
with  the  upper  bar  hook  may  he  so  made  that  it  can  he  easily 
disengaged  for  eating. 

Fig.  519. 


Fig.  520. 


An  appliance  for  reducing  the  prominence  of  the  centrals  and 
drawing  the  lower  jaw  forward  is  shown  in  Figs.  517  and  518. 
In  this  case  hands  were  cemented  to  the  centrals  with  the  studs 
lahially.  a  piece  of  retaining'  and  connecting  hand  Xo.  30  was 
punched  to  pass  over  the  studs,  cut  away  and  bent  to  form  a 
hook  at  each  projecting  end,  as  shown  in    Fig.  517.     Fig.  518 


374  ORTHODONTIA. 

shows  the  appliance  on  the  lower.  An  arch  bar  was  placed 
inside  the  arch  with  its  anterior  portion  resting  against  the 
incisor  teeth  between  the  studs  of  bands  on  the  laterals  and 
the  gum.  The  screw  bands  were  placed  on  the  molars  with 
their  screws  projecting  distally,  to  form  attachment  for  rubber 
ligatures.  Fig.  519  shows  the  casts  occluded,  with  appliances 
on  both  upper  and  lower.  The  screws  of  the  molar  bands  on 
the  lower  arch  and  the  hooks  formed  by  the  projecting  ends  of 
the  Xo.  39  attached  to  the  upper  centrals  are  connected  by  a 
rubber  ligature,  as  shown  in  Fig.  520.  In  this  manner  the  force 
to  reduce  the  prominence  of  the  upper  incisors  operates  to 
draw  the  lower  jaw  forward. 

Fig.  521. 


348.  In  tin-  case  shown  in  Fig.  521  the  upper  jaw  protruded, 
causing  an  abnormally  prominent  upper  lip.  The  arch  was  nar- 
rowed so  that  the  laterals  were  over-lapped  by  the  centrals  to 
quite  an  extent.  The  lower  arch  was  of  normal  prominence, 
but  the  lower  incisor  teeth  touched  the  gum  just  posterior  to 
the  upper  laterals.  The  upper  first  bicuspids  were  extracted 
and  the  arch  expanded  at  the-  same  time  the  prominence  of  the 
anterior  teeth  wa^  reduced  by  tin-  use  of  the  head  cap  and  pro- 


MISCELLANEOUS    CASES.  375 

trusion  bow.     Fig.  522  shows  the  case  after  this  part  of  the 
operation  had  been  completed. 

The  occlusion  of  the  teeth  was  far  from  perfect,  as  the  lower 
incisors  were  much  longer  than  they  should  be.  in  comparison 
with  the  molars  and  bicuspids.  This  is  often  the  condition  in 
cases  of  protrusion  ;  for  the  upper  teeth,  standing  so  far  for- 
ward, permit  the  lower  incisors  to  elongate  excessively  as 
they  meet  with  no  opposition  until  they  touch  the  gum.  In 
some  cases  it  seems  that  the  occlusion  of  the  teeth  prevents  the 
full  eruption  of  the  lower  bicuspids  and  molars  and  the  lower 

Fig.  522. 


incisors  touch  the  gum  above  although  they  are  not  abnormally 
long.  This  gives  an  appearance  of  lack  of  development  in  the 
lower  jaw.  making  the  first  and  second  subdivisions  (see  Fig. 
3),  less  than  twice  the  third  subdivision.  To  remedy  this  it  is 
necessary  to  depress  the  lower  incisors  to  some  extent,  and 
permit  the  bicuspids  and  molars  to  elongate. 

Fig.  523  gives  a  side  view  of  the  lower  arch  of  the  case 
shown  in  Figs.  521  and  522.  Fig.  524  shows  another  lower 
arch,  in  which  the  teeth  are  all  of  the  proper  relative  height. 
It  will  be  found  that  the  simplest  way  to  change  a  lower  arch 
from  the  condition  shown  in  Fig.  523  to  that  shown  in  Fig.  524, 


376 


ORTHODONTIA. 


will  be  to  band  the  upper  incisors  with  gold  bands,  having  a  V- 
shaped  lug  on  the  lingual  surface  of  each  band,  into  which  the 
lower  teeth  will  strike.  This  holds  the  molars  and  bicuspids 
apart,  permitting  them  to  elongate,  and  also  depresses  the 
lower  incisors.     Fig.  525  illustrates  this.     Each  tooth  is  banded 

Fig-  523- 


Fig.  524. 


with  a  20-carel  35-gauge  gold  baud,  shown  at  A,  a  lug,  P>.  is 
made  and  soldered  to  the  lingual  surface  of  the  band,  and  the 
lower  tooth,  C,  strikes  into  the  cup-shaped  depression  of  the 
lug.  This  lug  must  be  placed  in  such  a  position  as  to  hold 
the  bicuspids  and  molars  apart   the  desired  distance. 

Where    there    is    considerable    elongation    of    the    molars   and 

bicuspids  desired,  and  the  lowers  strike  some  distance  back  of 
the  uppers,  a  lug  of  the  shape  shown  at    E,   Fig.  520.  may  be: 


MISCELLANEOUS    CASES. 


377 


used.  As  the  cup  shaped  depression  in  this  lug  is  nearer  the 
cutting  edge  of  the  upper  tooth  the  l>ite  will  be  opened  more 
than  when  the  lug  is  placed  as  shown  in  Fig.  525.  Also,  the 
projection  1)  guides  the  lower  tooth  into  the  depression.    With 

Fig-  S2S- 


Fig.  526. 


young  patients  the  bicuspids  and  molars  will  elongate  quite  rap- 
idly and  very  often  the  condition  shown  in  Fig.  523  may  he 
entirely  prevented  by  the  use  of  this  device  while  the  bicuspids 
are  erupting. 


37« 


ORTHODONTIA. 


349.     Fig.  527  shows  a  case  in  which  the  lower  right  tem- 
porary cuspid  was  extracted,  permitting  the  permanent  incisors 
to  erupt  too  far  to  the  lingual,  which  often  results  in  the  con- 
Fig.  527. 


Fie.  ^28. 


dition  shown  in  Fig.  523.  The  upper  arch  may  be  of  normal 
prominence,  hut  the  lower  incisors,  standing  too  Ear  back  of  the 
uppers,  arc  permitted  to  elongate  until  they  touch  the  gum 
above.  Fig.  528  shows  the  position  the  teeth  would  have  occu- 
pied if  the  temporary  cuspid  had  not  been  extracted.  The  im- 
portance of  retaining  all  the  temporary  teeth  until  their  suc- 
r  is  ready  to  appear  cannot  be  too  strongly  emphasized. 


MISCELLANEOUS    CASES. 


379 


When  the  incisor  teeth  occupy  positions  as  shown  in   Fig. 

$2y.  they  should  be  immediately  moved  forward  and  the  space 
held  for  the  cuspid  until  it  appears.  An  arch  har  appliance 
used  inside  the  arch,  or  the  appliance  shown  in  Fig.  529  used 
on  the  outside  of  the  arch,  will  be  found  effective. 

Fig.  529. 


Fig.  530. 


350.  Whenever  the  upper  centrals  come  through  the  gum  in  a 
position  to  strike  on  the  lingual  surface  of  the  lowers,  as  shown  in 
Fig.  530.  their  positions  should  be  changed  before  they  have 
erupted  sufficiently  to  come  in  contact  with  the  lowers.  At  this 
time  the  upper  temporary  laterals  are  almost  always  in  position 
and  will  otter  sufficient  resistance  for  moving  the  permanent 


38o 


ORTHODONTIA. 


centrals  forward  until  they  strike  anterior  to  the  lowers.  The 
form  of  appliance  shown  in  Fig.  531  can  be  used  in  nearly  every 
case. 

As  soon  as  the  centrals  protrude  through  the  gum  one-eighth 
of  an  inch,  bands  may  be  cemented  to  them  with  their  studs 
labially,  a  piece  of  retaining  and  connecting  band  No.  39 
punched  to  pass  over  the  studs  and  bent  to  press  on  the  later- 
als as  shown  in  the  illustration.  By  bending  the  ends  of  the 
clamp  down  every  day  and  placing  a  piece  of  rubber  between 
the  ends  and  the  laterals,  the  centrals  may  be  moved  into  posi- 
tion in  about  a  week  in  almost  every  instance. 

Fig.  53 r- 


351.  In  cases  where  a  bicuspid  and  lateral  are  in  contact,  as 
shown  in  Fig.  ^32,  it  is  well  to  determine,  if  possible,  whether 
the  permanent  cuspid  is  in  position  to  erupt  if  proper  space  is 
made  for  it.  This  can  be  done  by  the  use  of  the  X-ray.  Fig. 
533  is  a  skiagraph  of  such  a  condition.  In  this  case  the  cuspid 
was  prevented  from  erupting  by  the  positions  of  the  bicuspid 
and  lateral.  After  the  bicuspid  and  lateral  had  been  moved 
apart  until  there  was  sufficient  space  for  the  cuspid  this  tooth 
came  through  the  gum  without  assistance. 

The  bicuspid  and  lateral  were  held  at  the  proper  distance 
from  each  other  by  banding  these  teeth  and  connecting  the 
Studs  of  the  bands  by  a  piece  of  retaining  and  connecting  band. 
The  studs  and  connecting  band  should  be  on  the-  outside  of  the 


MISCELLANEOUS     CASKS. 


381 


arch.  The  cuspid  erupted  slightly  to  the  lingual  of  the  line  of 
arch  and  was  drawn  into  position  by  rubber  ligatures  looped 
over  the  connecting"  band  and  passed  around  the  cuspid. 

If  a  cuspid  should  not  erupt  after  space  has  been  made  for 
it,  it  is  necessary  to  cut  through  the  gum  and  process  until  the 

I7i£-  532- 


W  " 

x 

V 

1 £  <y 

I  *  4 

Fig-  533- 


enamel  of  the  crown  is  exposed,  then  drill  a  hole  in  the  tooth 
and  set  a  pin  in  position.  By  looping  a  rubber  ligature  over 
the  connecting  band  and  attaching  it  to  this  pin  the  cuspid  will 
be  drawn  into  position. 


382  ORTHODONTIA. 

352.  When  a  cuspid  erupts  outside  the  line  of  the  arch  and 
there  is  sufficient  space  for  it  between  the  bicuspid  and  lateral. 
it  may  be  drawn  into  the  arch  by  the  use  of  a  rubber  ligature 
looped   over   a   piece   of    retaining   and   connecting   band   and 

Fig-  534- 


passed  around  the  cuspid  as  shown  in  Fig.  534.  In  this  case 
the  first  bicuspid  was  rotated  to  some  extent,  so  the  connecting 
band,  which  served  as  anchorage  to  move  the  cuspid,  was 
placed  in  position  as  shown  in  Fig.  535.     A  studded  band  was 

FiS-  535- 


cemented  to  the  central  with  the  stud  projecting  lingually  and 
a  single  socket  band  cemented  to  the  first  bicuspid  with  the 
clutch  tube  projecting  lingually.  A  piece  of  retaining  and  con- 
necting band  was  punched  t<>  pass  over  the  stud  of  the  central 


MISCELLANEOUS    CASES. 


38; 


band  and  cut  long  enough  to  reach  from  the  central  to  the  sec- 
ond bicuspid.  It  was  cut  narrower  its  entire  length  excepl 
where  the  hole  was  punched  for  the  stud  of  the  central  hand. 
The  distal  end  was  bent  so  it  would  rest  in  the  clutch  tube  of 
the  bicuspid  hand  edge-wise,  and  the  anterior  end  was  held  to 
the  stud  of  the  central  hand  by  a  retaining  clamp  nut  No.  38. 
This  forms  a  movable  joint  between  the  clutch  tube  of  the 
bicuspid  band  and  the  connecting  band,  permitting  the  bicuspid 
to  be  rotated  from  the  force  exerted  to  wedge  the  cuspid  in 
between  it  and  the  lateral. 

Fig-  536- 


A  studded  band  is  cemented  to  the  cuspid  with  the  stud 
lingually  and  when  a  rubber  is  passed  around  the  tooth  the  but- 
tons hold  it  in  position.  As  soon  as  the  cuspid  is  in  line,  all 
parts,  excepting  the  cuspid  band,  should  be  removed  and  when 
a  retaining  clamp  is  held  to  the  stud  of  the  cuspid  band  by  a 
nut  No.  38,  with  the  ends  of  the  clamp  bent  to  rest  on  the  adja- 
cent teeth,  the  case  is  effectually  retained. 

353-  Fig.  536  shows  a  retaining  and  connecting  band  at- 
tached to  a  lower  lateral  and  second  bicuspid  to  afford  anchor- 
age for  drawing  the  cuspid  buccally.  When  more  anchorage 
than  shown  in  the  illustration  is  necessary,  it  may  be  obtained 
by  permitting  the  ends  of  the  connecting  band  to  project  over 


384  ORTHODONTIA. 

the  molar  and  centrals.  The  connecting  band  is  cut  as  shown 
in  Fig.  537,  the  projections  A  and  B  afford  attachments  for  the 
rubber  and  may  be  placed  at  any  position  on  the  band  to  get 
the  proper  direction  of  force. 

Fig.  537- 


cr 


TJ 


354.  Fig.  538  shows  an  appliance  for  holding  the  lower  jaw 
rigidly  in  position  in  order  to  effect  the  union  of  a  fracture  in 
the  region  of  the  lower  right  lateral.  This  case  had  been  pre- 
viously treated  and  had  been  unsuccessful,  as  the  fracture 
would  not  unite.  The  lateral  was  very  loose  and  pus  was  dis- 
charging around  it.     It  was,  therefore,  extracted.     Both  ends 

Fig.  538. 


of  the  bone  were  trimmed  with  a  large  root  canal  reamer  and 
an  appliance  placed  in  position  as  shown.  In  this  case  all  bands 
ari  screw  clamped.  The  detail  <>[  the  appliance  which  connects 
the  left  lateral  and  right  firsl  bicuspid  is  given  in  Fig.  53<j,  and 
that  which  connects  the  second  bicuspids  is  given  in  Fig  =,40. 
The  combination  of  these  two  appliances  holds  tin-  ends  <>i  the 


M  ISCKLI.AXEOrS     CASKS. 


38i 


fracture  immovable,  as  was  proven  by  the  rapidity  with  which 
the  bone  united. 

The  appliance  shown  in  Fig.  539  is  contracted  until  the  ends 
of  the  bone  are  in  contact,  then  by  turning  the  long  nut  Xo.  26 
of  the  appliance  shown  in  Fig.  540,  as  indicated  at  A,  the  appli- 
ance is  expanded,  indicated  by  the  arrows  R  and  C,  just  enough 
to  bring  the  inferior  margins  of  the  maxillary  bone  in  contact. 

Fig-  539- 


Fig.  540. 


386 


ORTHODONTIA. 


355-  When  the  incisor  teeth  are  separated,  as  shown  in  Fig. 
541.  they  may  be  drawn  together  with  the  appliance  illustrated 
in  Figs.  542  and  543,  and  this  appliance  will  be  found  the  best 
form  to  use  in  all  such  cases. 

Fig-.  541. 


Fig.  542. 


Single-  socket  bands  are  cemented  to  the  incisors  with  their 
clutch  tubes  "ii  the  labial  surface  of  the  teeth  and  the  rec< 
openings  of  the  cluti  h  tubes  pn  ijecting  distally.  When  cement- 
ing the  bands  to  the  teeth  care  should  be  exercised  to  have 
the  clinch  tubes  in  perfect  line,  so  that  a  piece  of  threaded 
bar  will  pass  through  the  openings  of  the  clutch  tubes  without 
3sitating  bending.    Two  lock  nuts  No.  23  should  be  placed 


MISCELLANEOUS    CASES. 


387 


on  a  piece  of  threaded  bar  of  sufficient  length  to  pass  through 
the  clutch  tubes  and  project  one-sixteenth  of  an  inch  at  each 
end.  A  clutch  nut  No.  22  should  be  placed  on  each  end  of  the 
har  and  the  bar  then  passed  through  the  slotted  sides  of  the 
clutch  tubes.  The  rounded  portion  of  the  clutch  nuts  No.  22 
should  be  turned  into  the  recessed  openings  of  the  tubes  and 
the  nuts  No.  23  then  turned  against  the  opposite  ends. 

I7i.GT-  543- 

teHBfflMfflfflJ 


To  operate  the  appliance  the  nuts  No.  23  are  loosened  and 
the  nuts  No.  22  tightened.  This  draws  the  teeth  together.  A 
piece  cut  from  the  end  of  a  No.  35.  No.  53,  or  the  screw  of  a 
molar  band  may  be  used  for  the  bar. 

Fig.  544- 


356.  Should  it  be  necessary  to  move  one  central  more  than 
the  other,  or  to  reduce  the  prominence  of  the  teeth,  the  form  of 
appliance  may  be  changed  to  that  shown  in  Figs.  544  and  545. 
Bands  should  be  cemented  to  the  centrals  and  nuts  placed  on 


388 


ORTHODONTIA. 


an  arch  bar  No.  35  to  engage  the  clutch  tubes  of  these  bands  in 
the  same  manner  shown  in  Fig.  542.  The  molar  teeth  are  band- 
ed with  double  socket  screw  bands  and  two  nuts  No.  22  placed 
on  each  end  of  the  arch  bar  to  engage  the  clutch  tubes  of  these 
bands. 

Fig-  545- 


To  move  one  central  more  than  the  other,  the  nuts  engaging 
the  tube  of  the  band  on  this  tooth  should  be  tightened  more 
Frequently  than  those  engaging  the  tube  of  the  band  on  the 
other  central.  The  condition  should  be  corrected  in  this  man- 
ner when  the  center  line  of  the  face  is  nearer  one  central  than 
the  other. 

The  prominence  of  the  teeth  may  be  reduced  at  the  same 
time  they  are  moved  mesially,  by  loosening  the  clutch  nuts  at 
the  anterior  ends  of  the  clutch  tubes  of  the  molar  bands  and 
tightening  those  at  the  distal  ends.  This  moves  the  arch  bar  in 
the  direction  indicated  bv  the  arrows  l>. 


MISCELLANEOUS    CASES. 


389 


357.  Fig.  546  shows  a  case  in  which  both  upper  and  lower 
jaws  are  not  of  normal  prominence.  The  lower  incisors  stand 
to  the  lingual  of  the  proper  line  of  arch,  while  the  upper  cen- 
trals and  cuspids  over-lap  the  laterals.  This  case  had  heen 
spoiled  by  the  early  extraction  of  the  upper  first  bicuspids  to 

Fig.  546. 


Fig.  547- 


relieve  the  crowded  condition  of  the  arch,  without  placing  the 
teeth  in  proper  line.  It  was  simply  let  go  to  correct  itself,  with 
the  usual  result. 

To  correct  the  case  the  arch  was  first  expanded  to  the  extent 
shown  in  Fig.  549,  and  the  laterals  moved  forward  until  in  line 
with  the  centrals,  as  shown  in  Fig.  550.    The  cuspids  were  still 


390 


ORTHODONTIA. 


in  a  crowded  position.  Gold  bands  were  made  for  the  centrals 
and  laterals,  soldered  together,  and  this  retainer  cemented  to 
the  teeth  to  retain  them  (see  Fig.  551  )  while  with  an  arch  bar 
the  forward  movement  of  the  centrals  and  laterals  was  con- 
tinned. 

Fig.  54*. 


Fig-  549- 


A  thin  vulcanite  plate  which  rested  against  the  bicuspid  and 

molars  of  each  side  was  worn  to  hold  the  expansion.  The  up- 
pers wire  then  left  at  rest  for  three  months  and  during  this 
period  the  lower  teeth  were  moved  forward  by  means  of  an 
arch  bar  appliance  used  on  the  lingual  side  of  the  arch,  \iter 
this  was  done  the  occlusion  of  tin-  teeth  was  satisfactory,  but 


MISCELLANEOUS    CASES. 
Fig-  55°- 


39^ 


Fig-551- 


Fig-  552- 


392 


ORTHODONTIA. 


the  upper  incisors  slanted  forward,  as  shown  in  Fig.  552.  When 
this  is  the  case  it  is  necessary  that  the  incisal  edges  of  the  teeth 
should  remain  as  they  are  while  the  roots  are  moved  forward. 
To  accomplish  this  the  appliance  shown  in  Figs.  553  and  554 
has  proved  very  effective.  This  is  also  the  best  form  of  appli- 
ance to  use  for  tipping  the  roots  of  only  one  or  two  teeth. 

Fig-  553- 


In  this  particular  case  studded  bands  were  cemented  to  cen- 
trals and  laterals  with  the  studs  as  near  as  possible  to  the  incisal 
edges  of  the  teeth  on  the  labial  surface,  and  the  buttons  near 
the  gum  on  the  lingual  surface.  Double  socket  screw  bands 
wire  clamped  on  the  molars  with  the  clutch  tubes  on  the  lin- 
gual surface  of  the  teeth  and  the  long  screw  projecting  an- 
teriorly on  the  buccal  side  of  tbe  arch.  An  arch  bar  was  placed 
in  the  clutch  tubes  of  the  molar  bands,  resting  against  the 
incisor  teeth  between  the  buttons  of  the  bands  and  the  gum. 

A  piece  of  connecting  band  No.  39  was  fitted  to  tbc  anterior 
part  of  the  arch,  a  hole  punched  in  each  end  and  the  ends  bent 
at  right  angles  as  shown  at  II.  in  order  that  the  ends  may  be 
clamped  between  the  screw  band  nuts  A  and  B,  C  and  ]),  on 
the  -'Tew-  of  the  molar  bands.    Two-thirds  of  the  width  of  tbe 


\l  [SCELLANEOUS    CASES. 


393 


■entire  anterior  part  of  the  connecting  hand,  from  H  to  II,  was 
cut  awav  on  the  upper  margin.  The  band  then  rested  against 
the  labial  surfaces  of  the  incisor  teeth  between  the  studs  of  the 
bands  and  the  cutting  edges  of  the  teeth.  (See  Fig.  555.)  The 
relative  positions  of  the  arch  bar  No.  35  and  the  connecting 
band  No.  39   are  shown  in  Fig.  556. 

Fig-  554- 


When  the  nuts  engaging  the  clutch  tubes  of  the  molar  hands 
are  operated  so  the  arch  bar  moves  forward,  pressure  is  exerted 
in  the  direction  indicated  at  B.  When  the  nuts  B  and  D  (see 
Fig.  554)  are  loosened  and  the  nuts  A  and  C  tightened,  the 
connecting  band  No.  39  moves  in  the  direction  indicated  by  the 
arrows  MM.  This  moves  the  tip  of  the  tooth  in  the  direction 
indicated  by  the  arrow  C,  Fig.  556.  The  combined  action  of 
these  two  opposing  forces  moves  the  apex  of  the  root  in  the 
direction  indicated  by  the  arrow  A. 

When  it  is  desired  that  the  cutting  edge  of  the  tooth  should 
remain  stationarv  while  the  root  is  moved  forward,  the  nuts 


394 


ORTHODONTIA. 


A.  B,  C,  and  D,  are  left  firmly  locked  against  the  connecting 
band  while  the  movement  of  the  roots  is  accomplished  with  the 
arch  bar  portion  of  the  appliance. 

When  the  cutting  edge  is  to  be  retracted  and  the  apex  of  the 
root  moved  forward,  the  arch  bar  should  remain  locked  while 
the  movement  is  accomplished  by  operating  the  nuts  A,  B,  C, 
and  D. 

Fig-  555- 


Fig-  556. 


358.  An  appliance  for  moving  the  lower  anterior  teeth  back 
to  close  the  space  made  by  the  extraction  of  the  left  first  bicus- 
pid, is  shown  in  Fig.  557.  A  studded  band  was  cemented  to 
each  cuspid  with  the  studs  labially.  A  piece  of  retaining  and 
connecting  band  No.  39  is  placed  in  position  connecting  the 
studs  of  these  band-.    A  retaining  clamp  nut  No.  38  holds  the 


MISCELLANEOUS    CASES.  395 

connecting  band  to  the  stud  of  the  right  cuspid  band  while  the 
left  end  of  the  connecting  band  is  held  to  the  stud  of  the  other 
band  by  the  stud  bar  nut  No.  54,  which  connects  the  stud  bar 
appliance  with  the  left  cuspid.     When  the  nuts  at  the  clutch 

tube  of  the  molar  hand  are  operated  to  move  the  stud  liar  hack- 
ward  the  left  cuspid  is  retracted.  The  connecting  hand  moves 
the  incisors  as  the  cuspid  moves,  keeping-  all  the  teeth  in  line. 
The  amount  of  movement  decreases  from  left  to  right,  the  right 
cuspid  being'  only  slightly  rotated. 

Fig'-  557- 


359.  Where  the  incisor  teeth  over-lap  and  both  need  to  be 
rotated,  the  appliance  shown  in  Fig.  558  will  be  found  effective. 
Studded  bands  should  be  cemented  to  the  teeth,  one  with  the 
stud  labially  and  the  other  with  the  stud  lingually.  A  double 
jack-screw  is  anchored  to  a  molar  band  on  the  opposite  side  of 
the  arch,  and  one  of  the  jack-screws  connected  to  the  stud 
which  projects  lingually.  A  perforated  stud  No.  36  is  placed 
in  the  ball  cap  of  the  other  jack-screw  and  a  double  strand  of 
band  wire  Xo.  30  passed  through  the  hole  in  the  stud,  between 
the  teeth  as  shown  at  A  and  connected  to  the  stud  B  which 
projects  labially. 


396 


ORTHODONTIA. 


When  the  anterior  jack-screw  is  expanded  as  indicated  by 
the  arrow  E,  and  the  posterior  jack-screw  contracted,  indicat- 
ed by  the  arrow  F,  the  distal  surface  of  the  anterior  tooth  will 
he  moved  labially  while  the  mesial  surface  of  the  posterior 
tooth  will  be  moved  lingually.     The  continued  action  of  these 

Fig-  558. 


opposing  forces  will  place  the  teeth  in  line,  and  in  so  doing- 
will  force  the  other  teeth  apart  to  admit  them.  It  is  always 
well  to  bend  the  T  head  of  one  of  the  T  bars  as  shown  at  D, 
so  that  the  nuts  Xo.  25  will  be  a  sufficient  distance  apart  to 
permit  them  to  be  easily  operated  with  the  wrench. 

360.  In  cases  where  there  are  no  molar  teeth  to  afford  an- 
chorage, a  lateral  may  he  moved  into  line  by  anchoring  to  an 
opposite  bicuspid,  if  two  jack-screws  are  used.  One  jack- 
screw  should  extend  across  the  mouth  to  a  cuspid  or  central. 
This  reinforces  the  anchorage.  Tin-  second  jack-screw  can  then 
he  attached  to  the  No.  20  of  the  first  jack-screw  by  mean;-,  of  ;i 
T  socket    Xo.  31,  and  connected  to  a  hand  on  the  lateral.      See 


MISCKLLAXl'.nrS     CASKS. 


W7 


Fig.  559.     By  contracting  this  jack-screw  the  lateral  will  be 
drawn  into  line. 

fig-  559- 


Fig.  560. 


398 


ORTHODONTIA. 


361.  Fig.  560  shows  a  good  form  of  appliance  to  use  when 
one  or  two  molars  are  missing  and  the  bicuspids  have  separated. 
If  an  opposite  cuspid  or  lateral  is  to  be  moved  out  of  inlock,  it 
is  necessary  to  hand  both  bicuspids  and  the  remaining  molar 
and  connect  them  as  shown  in  the  drawing.  By  so  doing-  suf- 
ficient anchorage  will  be  obtained  in  nearly  every  case, 
although  the  molar  would  offer  very  little  resistance  if  used 
alone  or  in  connection  with  only  one  bicuspid. 

Fig.  561. 


362.  Fig.  56]  sh<»ws  a  combined  stud  bar  and  jack-screw  ap- 
pliance. An  appliance  of  this  form  may  be  used  to  draw  a 
cuspid  hack  and  move  a  central  forward,  to  give  room  For  a 
lateral,  or  to  reinforce  the  anchorage  of  a  molar  when  cither  a 
cuspid  is  to  be  drawn  back  or  a  central  moved  Forward. 

363.  When  any  of  the  bars  arc  to  be  cul  shorter,  after  the 
proper  length  has  been  ascertained  they  should  be  cut  with 
wire  cutters  and  the  bur  removed  with  a  file.     Alter  tin-  bar 


M  [SCELLANEOUS    CASES. 


399 


has  been  cut  it  will  he  flattened  and  widened  as  shown  at  A, 
Fig.  5<>2.  This  would  prevent  a  nut  being  placed  on,  or  taken 
off,  this  end  of  the  bar.  The  hie.  1).  must  he  held  at  right 
angles  to  the  bar,  E,  and  the  end  filed  to  the  point  B.     The  end 

of  the  bar  should  then  be  revolved  against  the  file,  holding  it 
at  an  angle  of  45  degrees,  to  finish  the  margin  as  shown  at  the 
opposite  end  of  the  bar  E. 


Fig-  563- 


364.  When  the  threaded  bars  are  to  be  bent,  they  should 
never  be  bent  around  a  square  corner,  nor  should  they  be  held 
with  steel  pliers,  as  the  threads  will  be  injured.  They  may  lie 
bent  with  the  fingers  or  as  shown  in   Fig.  563.     The  bar,  1>. 


4<X)  ORTHODONTIA. 

should  be  laid  on  a  flat  surface,  preferably  wood,  another  piece 
of  wood.  C,  should  be  cut  to  the  desired  shape,  pressed  firmly 
down  on  the  bar  and  the  end  D  of  the  bar  raised  until  in  con- 
tact with  the  rounded  surface  of  the  block  C.  Short  curves 
may  be  made  by  bending-  the  bar  around  a  lead  pencil. 

Fig.  564. 


365.  In  placing  bands  on  the  molar  or  bicuspid  teeth  they 
seldom  need  to  be  cut  narrower.  The  portions  which  project 
above  the  crown  of  the  tooth  at  the  interdental  spaces  should 
be  bent  down  into  the  sulci  as  shown  at  A,  Fig.  564.  This 
preserves  the  width  and  strength  of  the  band  and  prevents  its 
being  crowded  up  under  the  gum. 

Bands  should  never  be  contoured  with  crown  contouring 
pliers.     They   will,  invariably,  break  when    this  is  done. 


INDEX 


Age   for   correction,    46 

of  patient  fourth  point  in  diagnos- 
ing 1,   24 
Ala   of  nose,   angle   at.    3 

perpendicular   line  drawn   through, 
2 
Alveolar    process,    physiological    ab- 
sorption   of.    52 

bending,  33,  53,  181,  234.  236 
Anchorage,   jack-screw.   113 

reciprocal.   121.   123,   309 

reinforced  by  arch  bar  for  moving 
cuspid.    305,    306,    350 

reinforced    by    locking    molars    to- 
gether.   337 
Angle,  variations  of,    6 
Appliances,  author's.   57 

object   of,   57 

tightening  of,   77,   78 
Appliance    for    arch    expansion,    1S4- 
188 

composed  of  stud  bar  and  two  jack- 
screws,  329 

double  jack-screw  anchored  to  bi- 
cuspid. 396 

for  arch  expansion  and  moving  the 
laterals    forward,    1SS-192 

for  expansion,  extending  from  mo- 
lars to  laterals.  193-195 

for  moving  cuspids  labially.  320 

for  retracting  cuspid  and  first  bi- 
cuspid,  340 

for  retention.  162-172 

for  moving  incisors  laterally.  345 

for  moving  incisors  forward  and 
placing  cuspid  in  arch.  361-364 

for  moving  lower  incisors  forward. 
365 

for  reducing  prominence  of  upper 
centrals  and  drawing  lower  jaw 
forward.   373 

for  depressing  lower  incisors,  375- 
377 


for  fracture  of  lower  maxilla,  384 
for  drawing  centrals  together,  386 
for  drawing  together  and  reducing 

prominence  of  centrals,  387 
for  moving  roots   forward,   392-394 
for  major  protrusion,  207-236 
for     rotating     over-lapping     teeth, 

395 
jack-screw  and  stud  bar,  398 
moving    cuspids    and    laterals    dis- 
tally    with    protrusion   appliance, 
245-247 
operating    in   three    directions,    319 
stud    bar    and    jack-screw    moving 
lateral,  central  and  cuspid.  329 
Arch   bar  No.   35,   90,   91 

anchored  to  second  bicuspids,  mov- 
ing lower   incisors   forward.    146, 
147 
anchored  to  right  first  bicuspid  and 
left  first  molar   to   move  the   in- 
cisors forward,  147,  148 
anchorage  reinforced,  285 
appliance,  complicated  case,  297,  298 
appliances,   141,   282,  283,   349 
bending,    399 

moving    centrals     forward,     142 
moving  laterals,  in  connection  with 
retaining    and    connecting    band 
No.    39.    143.    144 
moving  lower  incisors  forward,  145 
moving  lower  cuspids,  150 
moving  upper  central  mesiaily  and 

lingually,    151 
moving  incisors  forward,  with  rub- 
ber    ligatures     drawing    cuspids 
lingually.   154 
moving  centrals  labially.   with   re- 
taining     and      connecting     band 
moving    laterals     lingually,     155, 
l  r,  •; .  157 
moving   centrals    and    laterals    for- 
ward,   314 


402 


INDEX. 


moving  centrals  forward,   325 

position  on  teeth  in  major  protru- 
sion.   221 

retracting  centrals.  31S 

to  disengage  from  clutch  tube,  68.' 
69 

to  disengage  from  clutch  tube  in 
protrusion  cases,  227 

used  in  connection  with  single 
socket  Viands  to  move  upper  in- 
cisors  forward.    153 

used  in  connection  with  rubber  lig- 
atures. 332 
Arch    expansion     by     bending    outer 
plate  of  alveolar  process,   181 

by  separating  the  superior  maxil- 
lary  bones,   182 

appliance  for,  1S4 

expansion  of,  55  Par.   72.   181 

moving  more  teeth  on  one  side 
than   on  the  other.  195-199 

to  place  appliance  in  mouth.  184, 
Par.  197 

retention  of,  183 

Ball  Cap  No.   24,  82 

bars  No.  21  and  No.  33,  left-hand 
threaded.  81 

bar  No.  57,  right-hand  threaded. 
81.  82 

bar,  bending  neck  of.  104 
Hands,  three  forms.  59  Par.  76 

advantages  of  wiring,  63,  64 

bicuspid.  66.  67 

cutting  narrower,    100 

contouring,  400 

double  socket  button,  67  Par.  88 

double  socket,  with  screw  attach- 
ment, 67,  68 

Incisor   and   bicuspid,   57-.60 

molar,    >'>^ 

studded  button,  .".9  Par.  77 

studded  button,  adjustable,  60  Par. 
78 

studded  button  with  screw  attach- 
ment,   61    Par.    79 

studded  button  with  extra  long 
stud.  61    Par.  80 

single  socket  button,  66  Par.  86 
Le   Bocket,    with   screw  attach- 
ment, 66   Par.   87 

to  apply,  ''.2 

to  cement,   65   Par.   86 

to  open  bite,  7 : ;  -  7  r, 

r.f  gold  with  nicks  for  reception  of 


arch    bar.    216 
wiring.  62 
Band  wire.  63  Par.  S2 
Bar-end   cap  No.   34,   90.   91 
Bar  hook  No.  55,  93 
Bars,   threaded,  cutting,  398 
Bicuspid,     retention     of     second.     273 
Par.    27S 
double  jack-screw  anchored  to.  396 
normal  occlusion  of  upper  first,   23 

Par.  20 
upper  first  as  landmark.  21.  22 
upper  first  one  step  forward,   24 
upper   first    one-half   step   forward. 
24 
Bicuspids,    extraction    of   upper   first. 
20.    349 
elongate  without  assistance,  293 
Bite,  length  of.  5 
lengthening    the.    5 
opening  the.  282.   283 
shortening  the.  5 
Bite   band,    73-75 

Cases,  miscellaneous,  280 

Cast  alone  not  sufficient  to  determine 

treatment.  1 
Cementing  bands  to  teeth.  65  Par.  S5 
Center  line,  second  point  in  diagnos- 
ing.   1.    17 
of    cast.    19 
of  face.   IS 

to  right  of  center  of  face.   20.   29 
Central,  inlocked.  movement  in  twen- 
ty-four hours.  53 
outstanding,  movement  in   twenty- 
four   hours.   53 
moving  labially  with  No.  39.  334 
Centrals,  moving  labially  with  No.  39, 
296,  297,  323. 
moving  labially  with  arch  bar.  325 
moving  labially  with  stud  bars.  326 
moving   labially   with  jack-screws, 
328 
<  ihuck,  to  place  on  arch  bar,  228,  229 
Clutch   tube,  double   socket,   descrip- 
tion  of,   68    Par.  89 
mil    No.    22,    76 

nut,    operation    of,    in    connection 
with     threaded    bar    and    clutch 
tube,  77   Par.  98 
Correction,  age  for,    16 

Importance  of  early,  50 
Cuspid,  retention  of,  272  Par.  277,  27:: 
Par.   27v  339 


INDEX. 


403 


appll  ince   for  elongating.    29 1 
moving    labially    with    jack-screw 

attached   to   arch   bar,   298 
moving  lower  labially,  383 
retracting    with    jack-screw,     305. 

Cuspids,    movement    in    twenty-foui 
hours,  55  Par.  71 
moving  both  labially,  320,  379 
Cutting  threaded  bars,   398,  399 

i>.  1  ichable  stud  No.  59,  94 
Depression  of  teeth,  230,  231 

Diagnosis  of  dental  irregularities.  1 
Distance    tooth    is    moved    each    time 
appliance  is  tightened.  77  Par.  99 
and   100 
teeth  may  be  moved  in  twenty-four 
hours.  51 
Divisions  of   face,    2.   3.   4 

Hist,  second  and  third.   2.   3, 
sub — .   first,  second,  and  third.   3.   4, 
1  'ar.  5 
Double  socket  button  bands.   67    Par. 

88 
Double     socket     button     bands     with 
screw  attachment.  67,  68 
auxiliary  T  socket  No.   :'>2.  85 
jack-screw.    121,    12  2 

Elongated  lower  incisors.   375 
Elongation    of    lower    bicuspids    and 

molars.   370.   37  7 
Expansion    of    arch.    55    Par.    72,    310 

31S 
appliance  for,  188-192,  3S9.  1S4 
by  bending  outer  plate  of  alveola! 

process.   181 
by    separating   the   superior   maxil- 
lary bones.  1S2 
of  lower  with  spring  appliance,  334 

335 
retention  of.   183 

to  place  appliance   in   mouth.   1S4 
to    move    more    teeth    on    one    side 

than  on  the  other.   195-199 
Extraction,  results  of  injudicious.   34 
of    lower    right    temporary    cuspid 

378 
of     temporary     second     molars.     34 

Par.  39 
of    temporary    cusi  ids.    ::4    Par.    40 

and  41 
of  temporary  laterals.   35   Par.    42 
of  permanent  teeth.  35  Par.   43 


of  upper  first  molars.  ::•;  Par.   14 
of    upper    and     lower    first    molars. 
r.    15 

of    molar    or    bicuspid,    results 

on  center  line.  36  Par.  16 
of  permanent   cuspids,  damag 

suiting,   3'',    Par.    is 

of  first  bic  ispid  inste  .,1  of  cuspid, 
:;7 

of  permanent  upper  centrals  or  lat- 
erals, 38    Par.  51 

of  lower  incisor  teeth.  :;:>  Par.  52 

t.i  give  room  for  other  than  right- 
ful successor.  35   Par.  42 

Facial  lines,  importance  of  consider- 
ing, 11 

Fracture  of  lower  maxilla.  ::s4 

Head  cap  No.    60,   99.   233 

position  of.  355,  :::,:. 
Hook,  for  attachment  of  rubber  liga- 
ture. 173   Par.   186 
for  connecting  arch  bar  to  studs  of 
bands.  215 

Ideal   facial   lines.   J 

Incisor,  rotation  of  central.  40.  159 

inlocked  central.   47 
Incisors,  lower,  over-lapping,  fs  Par. 
64 
early  correction   of  protruding  up- 
per. 49  Par.  07 
inward  slant   of  central.   17 
inlocked  upper.   17.   280-293,   344 
line  drawn  between,   is 
movement  forward  and  laterally  in 
twenty-four   hours.   53    Par.   70 
Inflammation,  indication  of.  52 
Interdental     spaces,     wide,     time     for 
correction.    Is 
between   lower   bicuspids,    2^e   Par. 
288 

Jack-screw  component  parts  of.  79-83 
anchorage.  1 13,  :'.!'s 
anchored     to    molar    and    bicuspid, 

114.  115 

anchored  to  two  bicuspids  and  mo- 
lar. 110 

anchored  to  molar,  bicuspids,  and 
cuspid,  117 

anchored  to  stud  bar.  307 

and  stud  bar  used  in  combination. 
312.   313 

changes  in  form,  110.  ill 

,1.  aide.   121.    122.  33S.   396 


404 


INDEX. 


expansion   and   contraction   of,    103. 

104 
limit  of  contraction.  109,  110 
moving  cuspid  out  of  inlock,  342 
moving  incisors  forward,  310.  328 
swivel  connection  with  base  of  an- 
chorage. 105 
triple.  123.  124.   347 
to  ascertain  length  of.  105-109 
with   extremely  wide  range   of  an- 
chorage, 118-120 
Jaw.   receding  lower,    6    Par.    11.    236, 
367 
moving  lower   forward.    6 
protruding   upper  with    chin   lack- 
ing  development.    12 

Land-mark,    upper   first   bicuspid.    21. 
22 
permanent  first  molar  not  reliable. 
22 
Lateral,  supernumerary,  case,  293 
appliance  for  moving  lower  labial- 
ly.  354 
Laterals,  retention  of,  272  Par.   277 
Lip,    upper,    short,    long    and    promi- 
nent  compared,   5    Par.   8 
curve  of  upper.   12   Par.    13 
prominent  lower,  6  Par.   10 
protruding   upper.   11.    12 
receding  upper,  11 
straight  upper,  12  Par.   13 
upper   curved    in    wrong    direction. 
17    Par.    14 
Lips,    prominence    of.    first    point    in 

diagnosing,    1 
Loch   nut   No.   23,  83 

Major  protrusion,  207 

appliance    lor  retention,   259-261 
case,   path-nt    eight  years  old,   237- 

with  arch  bar  attached  to 
single  sochet  bands  on  cuspids, 
240,  241 

moving   one  side  of  arch  only. 
242,   243 
one-half  of  arch   bar  used   on   one 
Bide  of  arch,  i\  i.  245 

with  laterals  to  the  liiigual 
of  line  oi   arch,  -18-250 

wiiii    laterals    to  the    lingual 
:i  mi  bicus  j'i'i  :i  ad  molar  miss  I  ng 

.villi  upper  teeth  slanting  for- 
ward,  '-'•"•  7.   268 


causes  for  lack  of  progress,  221 
Par.    234 

cementing  bands  to  molars.  221 
Par.    235 

change  in  alveolar  process,  234-236 

connection  of  a  molar  and  bicuspid 
to  reinforce  anchorage  for  reten- 
tion,  262 

connecting  two  molars  to  reinforce 
anchorage  for  retention,  263 

placing  chuck  on  arch  bar,  228,  229 

position  of  bands  on  molars,  218 
Par.    233 

requirements  of  appliance  for  cor- 
rection   of.   208   Par.    222 

test  for  proper  alignment  of  arch 
bar  and  clutch  tubes.  222  Par. 
236 

three  general  divisions  of,  207  Par. 
219,    22m.    221 

typical  case.    218 
Maxillary    bones,    separation     of,     55 
Par.    73 

reducing    size    of    superior.    33 
Measures,   studded  button  band,  59 

button   band   with    long   stud,    61 

bite  band.   7:1 

double  socket   button   band,   67 

double  socket  band  with  screw  at- 
tachment,   68 

single   socket    button   band,    67 

single  socket  band  with  screw  at- 
tachment.   67 

studded  screw  band,  61 
Miscellaneous   cases,   280 
Molars,    preservation    of   first    molars 
until   twentieth   year,   36   Par.    17 
Movement,  too  rapid.  52 

Nut   clutch.  No.  22,  76 

long   right   and    left   threaded,   No. 

25,  SO 

lock.    Xo.    -i:\.   83 

retaining  clamp,  No.  38,  92.  93 

shorl    right    and    lefl   threaded,  No. 

26,  80 

stud  bar,  No.  •",  i.  86  Par.  115,  89,90 

obtuse  angle  ;it  ala  of  nose. 
Occlusion,     of     bicuspid     teeth,     third 
point   in  diagnosing,   1,  21 

Pain,   Indication   of  too   rapid   move- 
men  i   ,,('  teeth,  52 
teet  h  moved  without,  52 


INDEX. 


405 


Patient,    position    to   show   profile,    25 
Peridental   membrane,  death  of,  53 
Perforated  stud  No.  36,  92 
Perpendicular  line,  2 
Physiological  tooth  movement,  52 
Points    to  be   considered   in   diagnos- 
ing, four,  1 

examples   of,    26 
Process,  mental,   lacking-,   12 
Proportion,   lines  of,    2 
Protrusion  cases,  movement  in  twen- 
ty-four hours,  56  Par.   74 

bow  and  chuck  No.  58,  95-97,  227. 
228 

case,  354   Par.   342 

see  Major  Protrusion 
Pulp,  strangulation  of,  53 

Receding  upper,  case,  280-293 

opening  bite,   282,   283 

lower    jaw,    appliance    for    correc- 
tion of,    367-373 
Removing  cemented  band,  65 
Retaining  clamp  No.  37,  92,  265 

and  connecting  band  No.  39,  93,  265 

and  connecting  band  connecting 
laterals,  135;  holding  upper  in- 
cisors and  cuspid  in  line,  137,  138 

and  connecting  band  No.  39,  to 
prepare,    267,    271 

and  connecting  band  moving  cen- 
trals  labially,   296,    297 

and  connecting  band  connecting 
cuspid  and  lateral,  310,  311 

appliance  for  protrusion  cases,  with 
retaining  clamps  on  laterals,  252, 
253 

appliance  for  protrusion  cases,  259- 
261 

appliance  holding  laterals  and  cen- 
trals in  contact,  290 

appliance  for  lower  incisors.  366. 
367 

central  incisors.  325 

clamp  nut  No.  38,  92,   93,  265 

cuspid,  339 

devices,   264 
Retention,  of  arch  expansion  by  rub- 
ber  plate,    183 

of  central,  lateral  and  cuspid,  273 
Par.   279 

of  cuspid  after  moving  from  in- 
locked  position,   2  T.'i 

of  four  incisors.  276  Par.  282 


of  laterals  after  being  moved  labi- 
ally.  251 

Of  laterals,    272    Par.    277 

of  lateral  and  first  bicuspid  while 
cuspid    is    erupting,    275    Par.    281 

of  left  lateral  and  cuspid,  273  Par. 
279 

of  lower  lateral,  277  Par.  284 

of  lower  bicuspid,  278 

of  lower  incisor  teeth,  278 

of  lower  cuspid  and  lateral,  278 
Par.   286 

of  six  anterior  teeth.  277 
Retraction  of  lower  arch.  394 
Roots,  moving  forward,  appliance  for, 

392-394 
Rotation,  159 

by  spring  action,  160  Par.  177 

by  directly  opposing  forces,  161 
Par.  17S 

by  two  jack-screws,  161  Par.  179 
and  180 

of  right  lateral  by  double  jack- 
screw,   163-165 

of  cuspid  by  jack-screw  and  stud 
bar,   165-168 

of  lateral  by  double  jack-screw 
anchored  to  bicuspid  and  molar, 
169.    170 

of  lateral  by  jack-screw  and  rub- 
ber ligature,   171,   172 

of  several  teeth  at  the  same  time, 
appliance  for,  173  Par.  187 

of  right  central  by  double  jack- 
screw  attached  to  separate  bases 
of  anchorage,  176,  177 

of  central  by  jack-screw  and  rub- 
ber ligature  attached  to  separate 
bases  of  anchorage,   179 
Rubber  plate  to  retain  expansion.  1S3 
ligatures   connecting  arch   bar  and 
laterals   in   protrusion   cases,   250, 
251 
ligature    to    cuspid,    294,    382 
ligatures   used    in    connection    with 

arch  bar.   332,  350 
piece    between    No.    39    and    cuspid, 

296 
under    ends   of   retaining   and    con- 
necting band,  325 
Rubbers     of     head     cap,     attachment 
from  protrusion  bow   to  buttons, 
230,    232 


AO(  i 


INDEX. 


regulation  of  tension,  230  Par.  247 
Rules   for  determining  treatment,  1 

Screw  band,  advantages  of  this  form, 

71,    72 
as  a  regulating  device,  200 
in    connection    with    retaining'    and 

connecting  band  No.   39,.  moving 

lower     anterior     teeth      forward. 

204,    205 
moving     upper     bicuspid     forward. 

200,  201 

moving     lower     bicuspid     forward. 

201,  202 

on    buccal    side    of    lower    arch    to 

move   bicuspid,    203 
with    rubber   ligature    drawing   bi- 
cuspid  lingually,  201,  202 
Single   socket   button   bands,    66    Par. 
86 
bands    with    screw    attachment.    66 

Par.    87 
auxiliary   T   socket  No.   31,    S5 
Sold. -red   bands,   disadvantages  of,   64 
Springs  No.   56,   94 

regulation    of   the    tension    in   pro- 
trusion   cases,    222   Par.    237 
tO    adjust.    223 

proper  tension  of,  224 

appliance    to    expand     lower    arch. 
334,   335 
Stud   bar   No.   53,  86,   89,   90 

appliances,   125 

appliance  moving  laterals  mosially. 
289 

and    jack-screw    used   in    combina- 
tion,   312,    313 

moving    laterals    forward.    131,    341 

moving  centrals   forward,  133 

moving    lateral    and    centra]     for- 
ward,   135-137 

moving    incisors    forward.    315,    326 

nut    No.  5  I.  86,  89,  90 

operation  of,  126 

retracting  first  bicuspid,  336 


retracting   cuspids.    128 

rotating   central,    130 

rotating  and  retracting  cuspid.   130 

used     in    connection    with     No.     39, 
134 

used    in    place    of    No.    20    in    jack- 
screw.    29S    Par.   301,    306 
Studded  button  bands,   59   Par.    77 

bands    with    screw    attachment,    61 
Par.    7:i 

button  hands  with  extra  long  stud, 
61    Par.    SO 
Subdivisions,   first,   second  and   third, 

3.    4 
Supernumerary    teeth,    41 

T    Bar    No.    20,    right    hand    threaded, 
S3 
No.   40.   left   hand   threaded.    S3 
cutting   for   arch    expansion    appli- 
ance,  1S5.    1S6 
long.   No.   19,   S6 

manner   of   inserting    T    head    in    T 
socket.  S6.  87 
T  socket   clutch   bar  No.    2S,   84 
double  auxiliary  No.  32,  S5 
single  auxiliary  No.   31,  85 
Tooth    movement.    51 
positive.    52 
too  rapid,   52 
Teeth   moved    without    pain    or   sore- 
ness,   5  2 
elongation.   53.    230 
never  extract  any  of  six  anterior, 

36   Par.   4  8 
supernumerary,  41 
Triple  jack-screw.  123,  124 

wiring  arch    bar   to  studs   of  bands, 

:'  l  5 
Wiring  button  bands,  62 
Wrench.    No.    29,   99 

placing  ball  cap  in  position,  100 
Wrenches,   right  and  left  No.  7o.  mi 

X'-Riiy.    use-    of.    :;so 


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